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By Richard Asinof
Patient-centered medical homes are rapidly becoming the sine qua non of health care delivery – and health care reform implementation – in Rhode Island, as the landscape shifts from hospital-centric to patient-centric care.
The transformation is built upon developing teams of caregivers to treat patients, viewing health care as a continuum, not as an series of episodic incidents, with a focus on primary care.
The transition involves more than just checking off a box and writing new policies, it involves commitment to a new way of delivering care, according to Lauren Capizzo, the senior manager of Health IT and Practice Improvement at Healthcentric Advisors.
She recently earned her National Committee for Quality Assurance’s Patient-Centered Medical Home Content Expert Certification, one of a handful in the state who have received such recognition. The organization’s focus is on transforming health care through measurement, transparency and accountability.
Providence Business News asked her to Capizzo to share her insights of what’s involved with practice transformation.
PBN: What is the significance of the new PCMH Content Expert Certification for patient-centered medical home practices?
CAPIZZO: Transforming a traditional physician office to a patient-centered medical home is a huge undertaking and often a daunting journey. Shifting from a physician-centered model to a team-based medical home – centered on the patient – includes expanding policies or standards of care, creating workflows for newly formed care teams, and collecting data for quality improvement and shared decision-making.
The change is so significant, even well equipped practices have challenges and barriers along the way. I believe this new certification for individuals that support practices represents the growing acceptance of patient medical home as the preferred model of care in the ambulatory setting.
PBN: There are only a handful of people in Rhode Island who have earned the certification -- including two at Healthcentric Advisors and two others at Blackstone Valley Community Health Center. What advantage does it bring to the physician's office or medical group?
CAPIZZO: Patient-centered medical homes are a foundational model to delivering consistent, quality care to patients. The new PCMH Content Expert Certification was important to me, and to my colleague Brenda Jenkins, because it enriches the first-hand experience we have in this field. It demonstrates that we understand the PCMH model from the national perspective. The practices we work with can be assured they will receive a credible, high-level of support and facilitation to adopt these standards, produce the required documentation, and navigate the application process for NCQA recognition.
PBN: Patient-centered medical homes in Rhode Island are rapidly becoming the norm. Blue Cross & Blue Shield of Rhode Island said that they have invested $60 million in the new model for delivery of primary care. The R.I. Chronic Care Sustainability Initiative says that more than 200,000 Rhode Islanders will be having primary care delivered through patient-centered medical homes in the near future. What makes them so attractive in terms of health care delivery?
CAPIZZO: As consumers, we know that health care costs are rising. Multiple strategies are underway to address these costs. The PCMH model shows promise for creating efficiencies and reducing redundancies in health care delivery while making an investment in quality.
Rhode Island’s health care community is ahead of the nation in regard to transforming the quality of our health care delivery model. You see this demonstrated throughout all our health care settings whether it’s the Chronic Care Sustainability Initiative, the top ranking of our state’s long term care facilities, the ICU collaborative, and our national recognition in Safe Care Transitions.
I think this is in large part to the shared, visionary leadership of those committed to health care locally which includes clinicians, payors, and elected officials.
Health care is also big part of our economy, and our ability to innovate and collaborate as a community is not just good for the health of our patients but for the health of our state. It’s an exciting time to be involved in the changes taking place locally and see how we stack up against others across the nation.
PBN: What kinds of analytics are needed to move forward -- to better measure patient outcomes and population health?
CAPIZZO: This is an important question. From a business and quality improvement perspective, the adage, “If you can’t measure it, you can’t manage it,” frequently drives my approach to evaluating change across a period of time or a certain data set.
The adoption of electronic health records and the capacity to view and exchange health information electronically and securely provides the robust data sources for clinicians to make decisions, and to more efficiently manage portions of their patient data.
However, while the data are now readily available and sortable, interpreting it for actionable, clinical or strategic decisions is still a real burden. Clinicians are expert problem-solvers but they didn’t get into medicine to manage mounds of data.
The next level of transformation for many practices will be carving out the resource to take information and map it to evidence-based guidelines that support an individual’s plan of care or for quality improvement across patient populations.
PBN: Is it hard for a physician or caregiver to manage their time within the new model of care? How does the new certification tie into that?
CAPIZZO: Practice transformation is more than just checking off a box and writing new policies, it involves commitment to a new way of delivering care. Under the PCMH model, the entire care team (clinicians and non-clinicians alike) are directly involved in not only a patient’s care but also a patient’s visit experience; there is an emphasis on patient satisfaction, patient engagement, and from a business perspective customer service. For example, the PCMH standards include expanding a patient’s access to their designated providers (including evening or weekend hours), ensuring patients are keeping their appointments with specialists or for important tests, and providing appropriate community resources to patients beyond a clinical intervention. Don’t forget providers also need to manage, track and interpret a plethora of data. These changes can be overwhelming for a practice to take on alone. This national certification, coupled with our team’s experience in quality improvement, gives practices an external partner to position them for successful transformation.