Washington Patient-Centered Medical Home Collaborative

Region Within State: 
statewide
Project Category: 
Multi-Stakeholder
PROJECT STATUS
Target Start Date: 
Wednesday, July 1, 2009
Pilot/Demo Length: 
2 years

33 primary care teams are working in patient-centered medical home improvements to culture and practice within their sites.

Mission: To implement medical homes in a variety of primary care clinics and improve the care of patients/families using the collaborative methodology.

 Goals

  1. Develop an implementation model for primary care medical home which:
    • Improves the patient and family’s experience of care
    • Improves primary care team satisfaction
  2. Examine overall health care utilization and costs impacted by medical home implementation.
Type of Practices: 
Family Practice
CONVENING ENTITY/PROJECT CONTACTS
Convening Organization Name: 
WA Department of Health jointly with Washington Academy of Family Physicians
Primary Contact: 
Pat Justis
E-mail: 
patricia.justis@doh.wa.gov
Phone: 
360-236-3793
Participating Stakeholders: 

Our Advisory Committe includes the following organizations:Group Health Cooperative of Puget Sound, University of Washington School of Public Health, University of Washington School of  Family Medicine, Aetna, CIGNA, Qualis Health, Puget Sound Health Alliance, Columbia United Providers , Molina Healthcare, Regence Health Plan, Community Health Plan of Washington, Premera Health Plan, United Health, WA Department of Social and Health Services, Washington Association of Community Health Centeres, Washington Health Care Authority,Northwest Physicians Network (IPA), First Choice Health Network, patient rep.

Participating Organization Types: 
Provider organization
Public payers
Private payers
academic institution
Health quality organizations, non-profit
EXPECTED OR ACTUAL DEMOGRAPHICS OF PARTICIPATING PRACTICES
Number of Practices: 
33
Number of Participating Physicians: 
755
Physicians per practice: 
varies
Types of Practices: 
Internal Medicine, Family Medicine
Health Plan Lines of Business Included: 
primary care
Overall Number of Covered Lives: 
700000
Technology Characteristics at Start of Pilot: 

All teams had to either have a registry or be willing to load a registry prior to project "panel freeze" on 1/1/2010. 100% of patients have registries, approx 75% have eletronic health registries. Percentage with practice management software; unknown.

Consumer Involvement: 

We have a patient on our advisory team and will seek more.  We held a patient panel discussion at our second learning session and plan to include patient participation in each learning session. We will be offering insruction on patient advisory groups, and patient participation in quality improvement teams is part of our change package.

PRACTICE TRANSFORMATION SUPPORT (INCLUDING TECHNOLOGY)
Focal areas of transformation: 

Our change package is focused around 8 key themes: ( each theme has multiple sub-bullets)

  • engaged leadership
  • quality improvement strategy
  • patient-centered interactions
  • organized, evidence based care
  • continuous and team based healing relationships
  • enhanced access
  • population management
  • care coordination

A number of our 33 practices were elgible for additional HIT grants sponsored by First Choice Network, and we offer the registry CDEMS free to participants  and fund free tech support for that registry.

Services participating practices have added as a result of their participation: 

Population management practices and job roles, redesign of team roles, enhanced access through evening and weekend hours, proactive outreach for prevention care, care coordiantion for emergency room patients and discharged inpatients, desktop medicine time, health literacy standards, planned care with previsits, group visits, self-managment action plans, patient experience interviews integrated into daily work, translation services for new lanagauges on site,  improved care protocols for chronic disease managment, integration of behavioral health, lean and advanced access quality improvemewnts, improved mediction reconciliaiton with a focus on older adults, improved advanced care planning for older adults, well child visit outreach, oral health screening for children,, phone outreach to the "most acute" patients from each day., soon to increase compacts and service agreements with specialists and emergency departments.

Technology that participating practices have added as a result of their participation: 

Working on refining registries and electronic health records, beginning to work on interoperability with other community providers, labs, imaging, hospitals and specialists.

Payment Model: 

Currently the teams receive a modest stipend ($6400) to compensate for time out of office to attend leanring sessions.  The stipends are supported by the contributions of six health plans. In addition, the Puget Sound Health Alliance and the Health Care Authority are planning a mutli-payer demonstration project that will involve many of the 33 teams in our project.

PROJECT EVALUATION
Types of data to be collected : 

We have five domains of evaluation:

  1. Patent experience;using a modified version of CHAPS
  2. Provider burnout using Malacsh inventory and team satisfaction using a survey instrument from Dartmouth Microsystems.
  3. Degree of Medical Home Implementation using the Medical Home Index
  4. Clinical measures; child, adult and geriatric prevention measures and the IPIP diabetes measures
  5. Cost /Utilization using claims data-we are still seeking funding for this domain of evalution but do have preliminary data sharing willingess secured from the health plans.
Which of the data types are being shared?: 

All data types will be shared.

Are the practices involved in the demonstration participating in any data sharing arrangements? If so please describe.: 

Participants agree to share all measures when they enrolled in the project; we have a fundamental value of transparency in this work.

Results to Share: 

We have just completed baseline and our first data roll up will occur in September 2010.

Relevant links: 

A major redesign and enlargement of the website is under construction and due for release within the next 30 days.

http://www.doh.wa.gov/cfh/wsc/default.htm