2015 module 1.1_build_a_medical_home_introduction.ppt (2)
TRANSCRIPT
© 2015 Pediatric Physicians’ Organization at Children’s (PPOC). For permission please contact [email protected]
Patient Centered Medical HomeModule 1.1
Introduction
© 2015 Pediatric Physicians’ Organization at Children’s (PPOC). For permission please contact [email protected]
© 2015 Pediatric Physicians’ Organization at Children’s (PPOC). For permission please contact [email protected]
Objectives
Module 1.1
• Identify key characteristics of a medical home
• List the partnerships within the medical home
• Recognize the four stages of team development
© 2015 Pediatric Physicians’ Organization at Children’s (PPOC). For permission please contact [email protected]
The Medical Home Model
Overview of the PPOC Medical Home Program: The PPOC focuses on providing high quality pediatric care and participating in quality improvement efforts in the member practices. The Medical Home Program supports and leads the practices in transforming the care delivery from reactive episodic care to proactive care. The aim of the PPOC Medical Home focuses on the PPOC Quality Compass which addresses the following: • Manage Population Effectively• Deliver High Reliability/Quality Care • Achieve High Patient Satisfaction• Reduce Total Medical Expense/Costs of Care
Module 1.1
© 2015 Pediatric Physicians’ Organization at Children’s (PPOC). For permission please contact [email protected]
The Medical Home Model
The PPOC Medical Home framework consists of three components:
1. NCQA Standards: These are based on the National Committee on Quality Assurance 2008 Patient Centered Medical Home 10 Must Pass Core Elements. These elements include increased access and communication with patients and families, organizing clinical information, identifying important diagnoses and conditions, adopt and implement evidence-based guidelines, test and referral tracking, population management, performance reporting and improvement. Practices are required to examine their current processes and make the necessary changes in their practices to meet these standards. As part of this effort, practices strive to implement processes that can be maintained as well as measure its effectiveness over time.
Module 1.1
© 2015 Pediatric Physicians’ Organization at Children’s (PPOC). For permission please contact [email protected]
The Medical Home Model
The PPOC Medical home framework consists of three components:
2. Care Coordination: Practices create a care coordination plan and hire a care coordinator. Care coordination is aimed at improving transfer of patient information and facilitating transitions in care. With care coordination, there is an emphasis on greater teamwork among the practice and following patients care before, during, and after the visit to pediatrician’s office. 3. Family Engagement and Partnership: Many practices are engaging the families in partnership with the clinical staff with the care of the child and in creating stronger medical homes within the practices. The practices are expanding and acting upon opportunities by adding families as a voice in the practice.
Module 1.1
© 2015 Pediatric Physicians’ Organization at Children’s (PPOC). For permission please contact [email protected]
The Medical Home Model
A Medical Home is not a building or a place.
It is an approach to providing comprehensive primary care that facilitates partnerships between patients, clinicians, medical staff,
and families.Module 1.1
© 2015 Pediatric Physicians’ Organization at Children’s (PPOC). For permission please contact [email protected]
The Medical Home Model
American Academy of Pediatrics Preamble to Patient-Centered Medical Home Joint Principles1: • Family Centered Partnership• Community Based System• Transitions• Value (Quality improvement)
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Characteristics of a Medical Home2,3,4
• Accessible • Comprehensive
• Continuous • Patient-Family Centered
• Coordinated • Compassionate
• Culturally Effective • Quality Services
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© 2015 Pediatric Physicians’ Organization at Children’s (PPOC). For permission please contact [email protected]
MHQP Medical Home Survey
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© 2015 Pediatric Physicians’ Organization at Children’s (PPOC). For permission please contact [email protected]
Medical Home Care Coordination Program
Care Team: MD, RNs, NP, Medical
Secretary, IT, CC
Planned Visits
Providers, nurses, secretaries, billing staff, CC
Education
Providers, nurses, CC
Care/Service Coordination
CC
Outreach Advocacy Access
CC
ReportsCC, IT
QICC
Medical Specialists/ED/Hospital
(Liaisons [BCH], practice/office managers, practice administrators)
Community Providers
Care Teams: Multiple providers working with
one patientsSchools,
Behavioral/Mental health agencies, Multiservice
agencies
Overall: Improve access to services and resources, and care planning and coordination which will lead to improved quality of care, health outcomes, and increased quality of life of children and youth with multiple medical and psychosocial needs.
Patients/Family: Increase understanding of specialty care, mental health services, educational services, out-of-home care, family support, and other public and private community services that are important for the overall health of the child and family.
Staff: Increase understanding of the elements of medical home and care coordination that impact the practice.
*Process Map Example from Greater Lowell Pediatrics
© 2015 Pediatric Physicians’ Organization at Children’s (PPOC). For permission please contact [email protected]
• Arriving at a medical home…not alone, engaging others
• A clearly identified improvement champion who is willing to lead the work
• Setting goals, discussing, reflecting, evaluating, setting new goals
• Engaging patients and families
• Fostering mutual support, communication, and relationships
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The Practice Medical Home Team
© 2015 Pediatric Physicians’ Organization at Children’s (PPOC). For permission please contact [email protected]
• Physicians• Care coordinators• Practice managers• Practice administrators• Nurses
• Nurse practitioners
• Billing and referral staff• Information technology staff• Social workers• Community members• Front desk staff
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The Practice Medical Home Team
A variety of additional members involved in processes
© 2015 Pediatric Physicians’ Organization at Children’s (PPOC). For permission please contact [email protected]
Promoting Medical Home Teams
Coming together is a beginning.Keeping together is progress.Working together is success.
- Henry Ford
Module 1.1
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What are Teams?
Standard definition of “Team”A group with a specific task or tasks, the accomplishments of which requires the interdependent and collaborative efforts of its members.
Module 1.1
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Why? Team structures in the practice setting have been known to…• Reduce physician workload• More time with each patient• See more patients
• Enable standardization of processes across the practice• Foster collaborative office culture• Improve practice-wide communication and understanding of
the underlying goal…buy-in from all• Facilitate and improve preventative and chronic care of
patients• Cultivate practice-wide innovations in patient care• Improve quality and satisfaction
Module 1.1
© 2015 Pediatric Physicians’ Organization at Children’s (PPOC). For permission please contact [email protected]
Stages of Team Development
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Stages of Team Development
• Forming– Defining a task
• Scope of the task and how to approach it
– Team Organization• Who does what?• When to meet?
• Storming– Different ideas compete for
consideration– Team members open up and
confront each other’s ideas and perspectives
– Necessary for Team growth– Can cause derailment…challenging
stage
• Performing– Team functions as a unit, highly
productive– Jobs get done smoothly and effectively– Team members are interdependent,
motivated and knowledgeable– Opposing opinions are welcomed, quickly
addressed and do not derail team progress
• Norming– A single goal is reached and a
mutually agreeable plan is outlined– Team works as a whole– Sacrifices are made by team
members for the betterment of the whole
– Conflicts are addressed and resolved more readily
Stages of Team Development
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Stages of Team Development
Have you been a member of a successful “Team”?
• What made it work?
• What challenges did you face?
Module 1.1
© 2015 Pediatric Physicians’ Organization at Children’s (PPOC). For permission please contact [email protected]
Stages of Team Development
Charter the “Team”• Identify the team members• Who will participate in the Team?
• Identify the purpose of the Team• Set a relevant goal• Relate this goal to a realistic problem/issue within the
practice that practice members would like addressed• Clarify support for the team (administrative help, relief
from other duties, etc.)• Clarify team relationship to practice management
structure/governanceModule 1.1
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Managing Meetings
• Before the Meeting• Agenda
• During the Meeting• Recorder• Timekeeper• Facilitator
• After the Meeting• Debrief• Minutes
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Teamwork
“Teamwork is the ability to work together toward a common vision,The ability to direct individual accomplishment toward
Organization objectives, it is the fuel that allows common people to attain
Uncommon results”
Module 1.1
© 2015 Pediatric Physicians’ Organization at Children’s (PPOC). For permission please contact [email protected]
Questions?
Add your questions and comments on the Module 1 Discussion Board on Blackboard!
Module 1.1
© 2015 Pediatric Physicians’ Organization at Children’s (PPOC). For permission please contact [email protected]
References1 Patient Centered Primary Care Collaborative. (n.d.). Joint Principles of the
Patient-Centered Medical Home. 2 The National Committee for Quality Assurance. (n.d.). Patient-Centered
Medical Home Recognition.3 U.S. Department of Health & Human Services. (n.d.). Defining the PCMH.4 Patient Centered Primary Care Collaborative. (n.d.). Joint Principles of the
Patient-Centered Medical Home.
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