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Medical Economics: Steinberg’s practice is textbook example of patient-centered medical home

Journal features Commonwealth Medicine physician leader

By Jennifer Rosinski

UMass Medical School Communications

June 05, 2014

The care coordination of an AIDS patient and his HIV-positive wife managed by UMass Medical School’s Judith Steinberg, MD, MPH, is a textbook example of success using the patient-centered medical home (PCMH) model, according to a cover story in the most recent issue of Medical Economics.

Dr. Steinberg (at right), clinical associate professor of medicine and deputy chief medical officer for UMass Medical School’s Commonwealth Medicine division, said that it was critical to have a behavioral health specialist immediately begin counseling the couple following their diagnosis.

That coordination would not have existed if Steinberg’s practice was not a medical home, one of 44 participants in the multi-payer Massachusetts Patient-Centered Medical Home Initiative (MA-PCMHI) sponsored by the Massachusetts Office of Health and Human Services.

“When I describe the patient-centered medical home to practices, providers, or to anyone—all of us are patients at one point or another—I like to say it’s really the way we, as patients, would like to see our care delivered,” Steinberg told Medical Economics.

“It makes such perfect sense that our care is focused on us as an entire individual, not as individual diseases or organ systems. That our care is well-coordinated and communicated across many settings and there’s an attention to quality and we are all partners in our care.”

The article, “Patient-centered medical home: Making care coordination work for your practice,” also included insight from Christine Johnson, PhD, PCMH quality improvement and transformation director at Commonwealth Medicine. She described how a physician reluctant to use care managers grew to appreciate them after they assisted in handling a complicated post-hospitalization patient. The physician said it was like “going from baggage to first class,” Johnson said.

Commonwealth Medicine is leading the development of the patient-centered medical home model and helping practices turn it into a reality. Led by Steinberg, Commonwealth Medicine has partnered with Bailit Health Purchasing LLC on MA-PCMHI. The three-year multi-payer demonstration concluded on March 31, 2014 and is in the analysis stage. Early results show 43 of 44 practices received National Committee for Quality Assurance PCMH recognition. Statistically significant improvement was shown in 11 of 22 clinical quality measures, including chronic disease management, prevention and care coordination. A complete evaluation and report is expected in the fall of 2014.

http://www.umassmed.edu/news/news-archives/2014/06/Medical-Economics-Steinbergs-practice-is-textbook-example-of-patient-centered-medical-home/

NCQA: Health IT Can Be Tapped To Support Patient Engagement

Friday, April 25, 2014

Successful integration of patient engagement tools into health IT systems has "the potential to improve inefficient communication methods and change the dynamic of the relationship between the patient and health care system," according to a new report from the National Committee for Quality Assurance, EHR Intelligence reports. 

However, the report noted that there is not yet a complete framework for boosting patient engagement through health IT systems.

Details of Report

In a survey, the report authors identified six common themes of "opportunities and challenges" related to patient engagement through health IT:

• Patient engagement is an untapped opportunity with major potential, especially among marginalized groups;
• Health IT should adopt a user-based model that originates from the needs and preferences of patients;
• There is a dearth of evidence on the effectiveness of such tools;
• Patient-engagement tools should be integrated into overall health care IT systems;
• Patient and consumer trust needs to be fostered; and
• Leadership and collaboration among stakeholders are necessary to realize the full potential.

The report also detailed four activities that will help the industry identify and develop a cohesive strategy for patient engagement through health IT, including:

• Developing joint principles that will facilitate the design, creation and adoption of health IT tools that boost patient care, improve overall population health and lower health care costs;
• Creating and implementing an evaluation framework that focuses on investment and prioritizes consumer choice;
• Facilitating the creation of a unified health data integration strategy focused on patient engagement; and
• Demonstrating innovative ways to use IT tools for patient engagement.

Comments

In the report, the authors wrote that "[h]ealth IT tools for patient engagement are often disconnected from the health care system and in need of full integration across all opportunities for engagement." However, the report added that successful integration of patient engagement in health IT systems has "the potential to improve inefficient communication methods and change the dynamic of the relationship between the patient and health care system."

NCQA President Margaret O'Kane said the "core idea" of the report is that health IT "should be designed around the needs and preferences of patients." She added that "the question of how to link [health IT] and patient engagement is an area where a unified strategy is most needed" (Murphy,EHR Intelligence, 4/23).

http://www.ihealthbeat.org/articles/2014/4/25/ncqa-health-it-can-be-tapped-to-support-patient-engagement

The next-generation set of standards for patient-centered medical homes, called PCMH 2014.

The National Committee for Quality Assurance has released a next-generation set of standards for patient-centered medical homes, called PCMH 2014.

The accreditation organization uses the standards to assess primary care practices seeking NCQA PCMH Recognition. About 7,000 practice sites with 35,500 clinicians have received recognition and that accounts for more than 10 percent of the nation’s practices, according to NCQA.

The new standards cover six primary areas: patient-centered access, team-based care, population health management, care management and support, care coordination and care transitions, and performance measurement and quality improvement.

Further, there are six must-pass elements necessary for recognition: patient-centered appointment access, components of the practice team, using data for population management, care planning and self-care support, referral tracking and follow-up, and implementing continuous quality improvement.

“To earn NCQA recognition, practices must meet rigorous standards for addressing patient needs; for example, offering access after office hours and online so patients can get care and advice where and when they need it,” according to the organization. “PCMHs get to know patients in long-term partnerships, rather than through hurried, sporadic visits. They make treatment decisions with their patients, based on patient preference. They help patients become engaged in their own healthy behaviors and healthcare.”

NCQA also continues to emphasize the importance of meaningful use of health information technology and health information exchange to support coordinated and patient-centered care, across provider sites.

According to NCQA, changes in the new standards include:

* Integrating behavioral health into a practice: Practices are expected to collaborate with behavioral health providers and communicate the benefits of such treatment to patients.

* Focusing care management on high-need populations:  Practices are expected to address socioeconomic drivers of health and poorly controlled or complex conditions.

* Enhanced emphasis on team-based care: This includes a higher emphasis on collaboration with patients and establishing team-based care as a “must-pass” criterion.

* Implementing the Triple Aim of care: Practices must demonstrate improving use of the three domains of Triple Aim--patient experience, cost and clinical quality.

* Sustained transformation: Practices must show they comply with NCQA standards over long periods.

The new patient-centered medical home standards are available here.

http://www.healthdatamanagement.com/news/NCQA-Sets-New-Higher-Standards-for-Medical-Homes-47568-1.html

HEDIS ICD-10 Recommendations Are Ready For Review

ICD-9-CM is an official classification system that practitioners currently use to code diagnoses and procedures on health care claim forms in the United States. Organizations use ICD-9-CM codes from claim and encounter data to identify diagnoses and procedures for HEDIS reporting. The Centers for Medicare & Medicaid Services (CMS) has mandated that health care providers switch from ICD-9 to ICD-10 Diagnosis and Procedure codes, effective October 1, 2014.

To accommodate this change, NCQA created a plan to identify a valid and appropriate set of ICD-10 codes for each HEDIS measure in time for inclusion in the HEDIS 2015 publications. This identification has been in progress for three years and is now complete. NCQA seeks public comment on the final recommendations for converting ICD-9 to ICD-10 codes in HEDIS measures.

NOTE: This process and timeline is separate from the HEDIS Public Comment process and timeline.

Reviewing the Recommendations

Because of the large number of codes being reviewed, NCQA is providing reviewers with more time than usual to look at the recommendations and provide comments and suggestions. We suggest that reviewers look at the recommendations and submit comments in sections or phases. Reviewers are asked to submit their comments in writing using the ICD-10 Public Comment form by 9:00am (ET) on Monday, December 16, 2013.

DOWNLOAD THE COMPLETE ICD-10 RECOMMENDATIONS IN PDF HERE

http://www.ncqa.org/Portals/0/PublicComment/NCQA_HEDIS_ICD-10_CodeRecommendations_20130701.pdf

'Real Answers' Panel Stresses Importance of Family Physicians in Health Care Transformation

September 27, 2013 03:52 pm Matt Brown San Diego – Family physicians are helping transform an uncooperative health care system into a patient-centered care delivery model that really works. But helping is not enough. It's time to start leading. That was the message delivered Sept 26 during the "Panel Session: Real Answers" at the AAFP Scientific Assembly here.

Panelists John Bender, M.D.; Marci Nielsen, Ph.D., M.P.H.; and Sam Nussbaum, M.D., offer "real answers" to some of the major issues facing family medicine during a panel discussion at the AAFP Scientific Assembly.

Panelists John Bender, M.D., senior partner and CEO at Miramont Family Medicine in Fort Collins, Colo.; Marci Nielsen, Ph.D., M.P.H, CEO of the Patient Centered Primary Care Collaborative (PCPCC) in Washington; and Samuel Nussbaum, M.D., EVP and clinical health policy and chief medical officer for insurer WellPoint Inc., told a standing-room-only crowd of family physicians that they are a central cog in the transformation process. The panel took questions electronically from AAFP members during the discussion.

"We haven't yet made the patient the real center of the medical home because, all too often, we stop at patient," said Nielsen. "We need to elevate the role of consumer in this process, because (consumers) are not yet demanding this model of care. If you want the (insurers) and Congress to pay for this model and reimburse primary care, you've got to start with patients and explain to them why it is so important."

AAFP LEADERS CONTINUE PANEL DISCUSSION

During the "Panel Session: Real Answers" at the AAFP Scientific Assembly in San Diego, panelists took questions from the audience that were submitted electronically. The volume of questions meant that some questions did not get answered.

However, the AAFP captured the questions the panelists didn't have time to answer, and the Academy's officers have agreed to respond to these questions via the AAFP Leader Voices blog. You also can sign up to receive e-mail notification when the Leader Voices blog is updated.

That is critical, Nielsen said, because, although groups like the AAFP and PCPCC are working hard in Washington and elsewhere to push for reform, insurers are only going to make real changes when employees begin demanding that employers pay for the patient centered medical home (PCMH) model.

"All of this can happen based on your leadership, but that means you can't just talk about this in your offices, you have to go out into your communities and talk about it, as well," said Nielsen. Primary care physicians "have got to keep leading and stepping outside of their comfort zone on this issue, because if not, we won't continue to be the 'it girl' of public policy that we are now."

Good evidence is another part of the payment equation, said Nussbaum. "We are developing different payment models for different (regional) settings, all based on performance and quality-of-care criteria," he said. "Family practice physicians can expect to see a 40 to 50 percent increase in total revenue based on value provided instead of patient volume."

Bender said he has found this to be true in his own practice, which is recognized as a PCMH by the National Committee on Quality Assurance (NCQA). "After we attained NCQA (recognition) for our PCMH transformation, we saw serious changes in quality," he said. "Hospitalization rates for our patients declined by 83 percent compared to our peers, while emergency room utilization by our patients was -218 percent compared to other practices in our area."

Bender said it is all a good story, but he cautioned that recognition or certification is not an end in itself.

"NCQA (recognition) is like a high school diploma -- you've accessed something, but it is not your career," he said. "Now you're licensed to go out and do it."

http://www.aafp.org/news-now/2013-cod-assembly/20130927answerspanel.html

Kaiser Permanente's Medicare Plans Are No. 1 Again

Kaiser Permanente Medicare plans hold top five spots in rankings; all Kaiser Permanente Medicare and Private plans are highest-ranked in the markets they serve

By Kaiser Permanente

OAKLAND, CALIF., SEPT. 19, 2013 — /PRNewswire/ -- Kaiser Permanente Medicare plans continue to demonstrate that they are the best in the nation, ranking No. 1 in a published report by the National Committee for Quality Assurance for the third year in a row.

The "NCQA's Health Insurance Plan Rankings 2013–2014" report is published annually and ranks health plans — Medicare, Medicaid and Private (Commercial) — in three categories, including customer experience, prevention and treatment. For the third year in a row, a Kaiser Permanente Medicare health plan is No.1 in the nation: Kaiser Permanente Southern California, which has been the nation's top Medicare plan for two years running. In 2011, Kaiser Permanente Northern California was top-ranked.

In addition, Kaiser Permanente Medicare plans hold the top five spots in the 2013-2014 rankings; Kaiser Permanente Northern California was No. 2, followed by Kaiser Permanente Northwest, Kaiser Permanente Colorado, and Kaiser Permanente Hawaii. These five regions account for 8.2 million of Kaiser Permanente's more than 9.1 million members. All eight Kaiser Permanente Medicare plans were in the top 16, which means all eight Kaiser Permanente plans are in the top 4 percent out of the 405 plans that were ranked.

In the Commercial rankings, Kaiser Permanente has three plans among the top 10 nationally for the second year in a row, including the second-highest ranked plan in the U.S., Kaiser Permanente Northwest. Also in the Top 10 were Kaiser Permanente Northern California (No. 7) and Kaiser Permanente Ohio (No. 10). All eight Kaiser Permanente Commercial plans are among the top 25 plans and therefore among the top 6 percent of the 484 ranked national plans.

All Kaiser Permanente plans ranked highest in both Medicare and Commercial in the regions or states they serve.

Kaiser Permanente Hawaii, for the third year in a row, retained its position as the No. 2-ranked Medicaid plan in the nation.

"We are proud to again have the highest-rated health plans in the markets that we serve," saidJed Weissberg, MD, senior vice president, Hospitals, Quality and Care Delivery Excellence, Kaiser Permanente. "Our consistently excellent performance in the rankings reflects Kaiser Permanente's commitment to helping our members get healthy and stay healthy. We have dedicated physicians and care teams who use best practices and cutting-edge tools to provide coordinated, compassionate care, creating a better, safer patient experience."

Kaiser Permanente's Commercial plans in Colorado and the Mid-Atlantic States and its Medicare plan in Colorado were also honored as "Best Value" plans, a new designation added to the rankings for the first time this year by NCQA. A "Best Value" plan, according to NCQA, is a plan that is "getting higher quality of care" and "avoiding costly care." Many health plans in the nation — including most from Kaiser Permanente — chose not to collect or report the necessary data that would determine whether they were a "Best Value" plan, and therefore were not eligible for that designation.  

Now in its eighth year, the "NCQA's Health Insurance Plan Rankings" is based on combined scores for health plans in Healthcare Effectiveness Data and Information Set®, commonly called HEDIS; the Consumer Assessment of Healthcare Providers and Systems®, or CAHPS; and NCQA Accreditation standards scores. Consumers and employers assess plans prior to annual enrollment periods.

In the Medicare category, with 405 plans nationally ranked, Kaiser Permanente had the following rankings:

• Kaiser Permanente Southern California — 1st
• Kaiser Permanente Northern California — 2nd
• Kaiser Permanente Northwest — 3rd
• Kaiser Permanente Colorado — 4th
• Kaiser Permanente Hawaii — 5th
• Kaiser Permanente Mid-Atlantic States — 8th
• Kaiser Permanente Ohio — 11th
• Kaiser Permanente Georgia – 16th

Kaiser Permanente Hawaii was the only Kaiser Permanente plan eligible for the Medicaid rankings. The Hawaii plan ranked second in the nation out of 131 plans. Other Kaiser Permanente regions are not required to report data on the full set of measures used to calculate Medicaid rankings and were therefore unranked in this category.

Out of 484 nationally ranked Commercial plans, Kaiser Permanente had the following rankings:

• Kaiser Permanente Northwest — 2nd
• Kaiser Permanente Northern California — 7th
• Kaiser Permanente Ohio — 10th
• Kaiser Permanente Colorado — 13th
• Kaiser Permanente Mid-Atlantic States — 16th
• Kaiser Permanente Southern California — 17th
• Kaiser Permanente Georgia — 20th
• Kaiser Permanente Hawaii — 25th

"Our high ratings recognize Kaiser Permanente's superb physicians and care providers," said Amy Compton-Phillips, MD, associate executive director for Quality at The Permanente Federation, the national umbrella organization of more than 17,000 physicians who provide care to Kaiser Permanente's more than 9.1 million members. "This recognition, however, is not merely about rankings. These scores demonstrate that at Kaiser Permanente improving the health of our members is our calling. We continuously strive to improve and provide better care to the more than 9.1 million Kaiser Permanente members we serve."

The rankings and methodology are posted on the NCQA's website at www.ncqa.org and on theConsumer Reports website. The rankings and an article about health plans will appear in the November issue of Consumer Reports magazine.

http://www.heraldonline.com/2013/09/19/5226568/kaiser-permanentes-medicare-plans.html

Read more here: http://www.heraldonline.com/2013/09/19/5226568/kaiser-permanentes-medicare-plans.html#storylink=cpy

NCAQ Transitions Measures to ICD-10, Seeks Comment

The National Committee for Quality Assurance, an accreditation firm, is soliciting public comments on proposed changes to HEDIS performance measures on providers and payers as the nation transitions to the ICD-10 codes.

The ICD-10 codes, effective in October 2014, will be part of the HEDIS 2015 measures, which NCQA will release in July 2014. “To accommodate this change, NCQA created a plan to identify a valid and appropriate set of ICD-10 codes for each HEDIS measure in time for inclusion in the HEDIS 2015 publications,” the organization explains. “This identification has been in progress for three years and is now completed. NCQA seeks public comment on all of the final recommendations for converting ICD-9 to ICD-10 codes in HEDIS measures.”

Because of the large number of codes being reviewed, NCAQ is offering a long comment period with a due date of Dec. 16, 2013. Details on the changes and comment procedures are available here.

NCQA also has released the 2014 edition of technical specifications for HEDIS measures, including a new measure on non-recommended cervical cancer screening in adolescent females. Changes also were made in existing measures covering breast cancer screening, cervical cancer screening for adult females, care for older adults, potential drug-disease interaction in the elderly and relative resource use. More information is at ncqa.org/publications.

http://www.healthdatamanagement.com/news/ncqa-hedis-coding-icd-10-performance-measures-46357-1.html

NCQA Making Changes to Medical Home Program, Seeks Comment

The National Committee for Quality Assurance, a health care accreditation firm, has released for public comment proposed changes to standards for the fifth iteration of its patient-centered medical home recognition program.

Changes emphasize outcomes measures, resource stewardship such as avoiding duplicate services, and targeting resources based on patient needs. Increased applicability of standards to pediatric practices, alignment with Stage 2 EHR meaningful use requirements and integrating behavioral health with primary care also factor into changed standards. More information on accessing the changes and making public comment, due July 22, is available here.

NCQA this year has introduced two new initiatives to support the existing core medical home recognition program. In January, it announced a new program to credential medical home “content experts” and posted its first 100 credentialed experts from 29 states in May. In March, NCQA introduced a patient-centered medical home recognition program for physician specialists outside of primary care.

http://www.healthdatamanagement.com/news/ncqa-recognition-accreditation-certification-medical-home-comment-46294-1.html