Post Call Agenda, Thursday, September 16th, 11:00 AM EDT

B. Bill To Establish Medical Home Project In New Jersey Signed Into Law

A bill which establishes a medical home demonstration project to enhance primary, patient-centered acute care for Medicaid recipients was signed into law last week by Gov. Chris Christie.

The new law, S-665, requires the State Medicaid program to establish a three-year Medicaid medical home demonstration project to expand the options for Medicaid recipients to receive patient-centered, coordinated primary care.  The new law requires that the Medicaid program consider payment methodologies that support care-coordination through multi-disciplinary teams and health care specialists. To learn more, please click here.

C. HHS Awards $17 Million for Patient-Centered Outcomes Research

HHS Secretary Kathleen Sebelius today announced three sets of grants and cooperative agreements totaling nearly $17 million for patient-centered outcomes research (PCOR), or research that compares treatments and strategies to improve health outcomes for patients.

The three-year funds, made available under the American Recovery and Reinvestment Act of 2009 through the Health Resources and Services Administration (HRSA), will establish a network of PCOR centers, enable PCOR in pediatric emergency medicine, and support building capacity for community-based providers to engage in this type of research.

“Patient-centered outcomes research can improve health outcomes by developing and disseminating evidence-based information to patients, providers and decision-makers about the effectiveness of different treatments,” said HHS Secretary Kathleen Sebelius.

HRSA Administrator Mary Wakefield said: “These funds allow us to invest in robust systems and infrastructure to bring patient-centered research knowledge into everyday clinical decision-making for the diverse and vulnerable populations that HRSA serves, and that are often under-represented in this kind of research.”

Five cooperative agreement awards will go to organizations in four states to create the Community Health Applied Research Network (CHARN) to demonstrate that safety net providers and academic institutions can partner together to create an effective infrastructure that supports patient-centered outcomes research. This network in particular will provide an opportunity to evaluate patient-centered outcomes research among diverse populations and patient subgroups that are not always adequately represented in similar studies.

The CHARN consists of a Central Data Management Coordinating Center, based at the Kaiser Foundation Hospitals’ Center for Health Research in Portland, Ore., and four networks selected as research “nodes” in California, Illinois, Massachusetts and Oregon.  The nodes are geographically dispersed consortia of safety net providers in 17 states.

Three of the four research nodes will focus on patient-centered outcomes research related to the delivery of primary care, while the fourth (in Boston), will focus more specifically on research that is relevant to the care and treatment of individuals with HIV/AIDS.

Another grant totaling $3.5 million will be awarded to Columbia University to support patient-centered outcomes research within the Pediatric Emergency Care Applied Research Network (PECARN). The funds will help boost data capacity, conduct studies and disseminate information on research findings involving pediatric emergency care.

Separately, a grant totaling $3.5 million will be made to the American Academy of Pediatrics at Elk Grove Village, Ill., to support development of an electronic health record sub-network within the Pediatric Research Network in the Office Setting, the nation’s largest pediatric primary care research network. The results from this work will be used to inform guidelines and policies of pediatric practice.

To learn more, please click here.

D. Health Affairs and Robert Wood Johnson Foundation Health Policy Brief

Patient-Centered Medical Homes. A new way to deliver primary care may be more affordable and improve quality. But how widely adopted will the model be?

Patient-centered medical homes are considered by many to be among the most promising approaches to delivering higher-quality, costeffective primary care, especially for people with chronic health conditions. Although there is no single standard definition of a medical home, there is an agreedupon set of principles behind the concept, and most medical homes share common elements. For example, each patient has close contact with a clinician (physician, nurse practitioner, or physician assistant) for continuing care, and that clinician takes the lead when referring the patient to specialists. Medical homes also make extensive use of electronic health records and seek active participation of the patient and his or her family. Health care reform legislation authorizes the Department of Health and Human Services (HHS) to test medical homes among other new care-delivery models. Supporters hope patient-centered medical homes will help refocus the U.S. health care system on the benefits of primary care. This brief describes recent projects that have applied patient-centered medical home concepts, as well as concerns about widespread adoption of the model before results are definitive.

To read the entire brief, please click here.

E.  N.Y. Awards $109 Million to Push Medical Homes

New York awarded a combined $109 million in health information technology grants to promote medical homes to 11 hospitals, health information exchanges and other health care organizations, the state’s health department announced.

The grants will focus on coordination of mental health, long-term care and home health care, according to a news release. The New York City Health and Hospitals Corp. received a $10 million grant for a project that focuses on schizophrenia patients. The grants were awarded through New York’s Health Care Efficiency and Affordability law and the Federal State Health Reform Partnership, the release said. To learn more, please click here.

F.  Health Affairs Study Finds More Americans Bypassing Their Personal Physician When Immediate Treatment Required

Only 45 percent of the 354 million annual visits for acute care in the United States are made to patients' personal physicians, as Americans increasingly make busy emergency departments, specialists or outpatient care departments their first point of contact for treatment of new health problems or a flare up of a chronic condition like asthma or diabetes.

The findings, which appear in the September edition of Health Affairs, do not bode well for the nation's already busy and frequently undermanned emergency rooms. While fewer than five percent of doctors across the U.S. are emergency physicians, they handle more than 28 percent of all acute care encounters - and more than half of acute care visits by the under-and uninsured.

According to co-authors including Steven Pitts, MD, associate professor of medicine in the Emory School of Medicine and a staff physician at Emory University Hospital Midtown, and Arthur Kellermann, MD, the Paul O'Neill Alcoa Chair in Policy Analysis at the RAND Corporation and previous associate dean for health policy at Emory University, health reform provisions in the Patient Protection and Affordable Care Act that advance patient-centered medical homes and accountable care organizations are intended to improve access to acute care. However, the challenge for reform, according to study authors, will be to succeed in the complex acute care landscape that already exists.

The study, which took place between 2001 and 2004, shows that Americans made an average of 1.09 billion outpatient visits per year to physicians, averaging 321 visits per 1,000 people each month. Slightly more than a third of all encounters, or 354 million per year, were for acute care — treatment of new problems or a flare-up of a chronic health condition.

Twenty-two percent of acute care visits were managed by general/family practitioners, 10 percent by general internists and 13 percent by general pediatricians. Many involved treatment of minor upper respiratory problems, such as cough and sore throat. Office-based specialists handled 20 percent of acute care visits, generally for conditions in their respective areas of expertise (e.g., skin, eye and orthopedic problems). Twenty-eight percent of acute care visits were managed by hospital emergency departments, typically for more complex and potentially dangerous conditions such as stomach and abdominal pain, chest pain and fever.

To read more, please click here.

I.  California Passes Patient-Centered Medical Home Legislation

American Academy of Family Physicians - The California legislature has approved a measure that establishes criteria for patient-centered medical homes in the state.

The legislation, known as the Patient-Centered Medical Home Act of 2010, defines the medical home as a health care delivery model in which a patient establishes an ongoing relationship with a physician or other licensed health care professional "acting within the scope of his or her practice." According to the legislation, the medical home employs a physician-directed practice team to provide comprehensive, accessible and continual evidence-based primary and preventive care, while coordinating the patient's care across the health care system to maximize quality and health outcomes in a cost-effective manner.

To qualify as medical homes, practices must adhere to quality standards that seek to

• reduce disparities in health care access, delivery and health care outcomes;
• improve quality of health care and lower health care costs;
• integrate medical, mental health and substance abuse care; and
• remove barriers to receiving appropriate health care.

II. Important Links

October 22 Annual Summit Materials - click here

• ActiveHealth Management
• Arizona Pharmacy Alliance
• Clarian Health
• Health Care For Everyone-Alabama
• Palmer Healthcare,LLC

I. Introductions

On July 8th, the Center co-sponsored a webinar with the CMD featuring:

• Joslyn Levy and Dana Stephenson  of the NYC Dept. of Health presented on the innovative Primary Care Information Project.  The webinar is now posted on the Collaborative's website.  There were over 150 participants on the presentation.

On the Center's recent call, on May 28th, the following occured.

Presentation:  

Hear About & Discuss Promising Practices in the Field 

Susan Edgman-Levitan, PA, Executive Director of The John D. Stoeckle Center for Primary Care Innovation at the Massachusetts General Hospital. 

Susan is a constant advocate of understanding the patient’s perspective on healthcare. She is a member of the PCPCC Board of Directors and recently served as a guest editor for the Health Affairs journal on Primary Care. 

Summary of Last Call: 

Agreed on goals, domains, and general process for our work.

Discuss Definition of “Consumer Involvement” 

Review and discuss working definition of “consumer engagement”/”consumer involvement.”

Consumer involvement means ensuring patients and/or families provide input into the design, ongoing practice and evaluation of whole person, patient centered, accessible and coordinated medical care and services.