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Rural Health Webinar:Strengthening Health Systems in Resource-limited Settings
R.W. Watkins, MD, MPH, FAAFP
Institute for Emerging Issues (IEI) at NC State University
and Duke University
9 April 2014
What is the Multi-Payer Demo?
The purpose of the Multi-Payer Advanced Primary Care Practice “demonstration project” (MAPCP) is:
To evaluate the effectiveness of the Patient Centered Medical Home (PCMH) model, when supported by both public (Medicaid and Medicare) and private payers (Blue Cross Blue Shield, and State Health Plan)
To utilize care management for these other payer sources
What is the Multi-Payer Demo?
NC is one of 8 states that was awarded an MAPCP demo
7 rural counties across NC were chosen to participate in the demo: Ashe, Avery, Bladen, Columbus, Granville, Transylvania, and Watauga
Patient-Centered Medical Home
The PCMH is a model of primary care re-design intended to improve the quality and efficiency of primary care delivery
What we have… What we need!!
Atul Gawande, MD
Benefits of the PCMH Model
Quality – Outcomes for seven medical home demonstrations
Fewer ER visits (15%-50%)
Fewer hospital admissions (6-24%)
Lower mortality rates
Better preventive service delivery
Better chronic disease care
Higher patient satisfactionSource: Neilson, M, et al. The Medical Home's Impact on Cost & Quality, An Annual Update of the Evidence, 2012-2013, January 2014
Benefits of the PCMH Model
Efficiency – Cost
Lower total costs of care - (6.5-22%)
Shorter patient wait times
Less staff burnout/turnover (10% Vs. 30%)
Higher staff satisfaction/productivity
Source: Neilson, M, et al. The Medical Home's Impact on Cost & Quality, An Annual Update of the Evidence, 2012-2013, January 2014
This is a No-Brainer! Right?
So Why Aren’t Practices RUNNING to implement PCMH for themselves?!?
1. Time
2. Resources
3. Consultants are expensive
4. Fear
a) Gov’t interference
b) Loss of control/independence
c) Change
How Do You Get All This Done?
ASU Practicum in Primary Care
ASU College of Health Science, School of Healthcare Management
Watkins. Journal of Medical Practice Management,Sept/Oct 2012, Vol 28:2, pp. 134-6.
Creation of Partnership with Appalachian State University
PARTNERSHIP:
Recruit ASU students from School of Health Care Management
Develop curriculum, syllabus, website, core documents
Create new practicum course with internship opportunity
Teach students about PCMH, Provider Portal, Care management process
Send students out to practices to assist in attaining PCMH certification, BQPP cert and QI initiatives
ASU Practicum in Primary Care
Fall of 2011 – 5 students
Spring 2012 – 9 students – BSBSNC Foundation Grant Obtained
Summer 2012 internship – 8 students
Fall 2012 – 14 students
Spring 2013 – 15 students
Fall 2013 – 16 students
Spring 2014 – 15 students
ASU Practicum in Primary Care
Developed curriculum, core documents, website https://sites.google.com/site/pcmhprac/
Program Growth
ASU School of Health Care Management has made the “Practicum in Primary Care” a CORE curriculum class
Students willing to spend 2 semesters with us get full credit for their internship (300 hours)
“Keeping the Medical Home Fires Burning” is a new initiative where practices that have been recognized work with students on QI projects
Program Growth
Remote Learning Initiative
Students work with practices within 3 hours of Boone
MOVI (secure) web-hosting
Face-to-face visits every 3 weeks or so
CCNC’s PCMH Efforts
Beginning of MP ProjectBeginning of
MP Project
Rural Health Webinar:Strengthening Health Systems in Resource-limited Settings
R.W. Watkins, MD, MPH, FAAFP
Institute for Emerging Issues (IEI) at NC State University
and Duke University
9 April 2014