Posts Tagged ‘medical_home’

Now Reading: 25 Percent of Large Medical Groups Use Data from Patients to Improve Care

October 14th, 2008 | Popularity: 34%
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Only 10 percent reported that most of their physicians would strongly agree with statement that the group regularly incorporates feedback from patients in improving care and developing new services.

This is among the largest medical groups, the ones with the greatest infrastructure.

This figure comes from the attached article, published in Health Affairs , which is a survey of a sample of the largest medical groups in the United States (those with 20 or more physicians), with the exclusion of Independent Practice Associations (due to theoretically less infrastructure present), and via self-report of the CEO’s/Presidents/Medical Director. In other words, this is best case.

With regard to online access:

Thirty percent of medical groups use group visits for patients with chronic illnesses at a majority of their practice sites (data not shown). A similar proportion reported that most of their physicians communicate with patients via e-mail “occasionally,” although only 1 percent reported that physicians use e-mail with patients daily. Nine percent said that a majority of their patients could access some part of the group’s EMR online.

Unfortunately, the performance of the medical groups surveyed lessens as the size of the group does. I thought it might be possible that smaller practices in this group might employ greater efforts to incorporate patient feedback. That could still be the case, since groups with less than 20 physicians are not included here (and those are the overwhelming majority of places where Americans receive their ambulatory medical care).

What about measuring “Medical Home-ness”?

Although some argue that “ medical-homeness” is better evaluated from the patient’s perspective than from the physician’s, others balk at all attempts to measure aspects of the PCMH as overly reductionist. Regardless, the demand for clinical practice “ transparency” remains a reality of the current policy environment, and success of the model will depend in part on continued multistakeholder involvement in the development of standardized, comprehensive assessment tools.

How, in a Health 2.0 world, could we combine the significant expertise of NCQA and lighter weight solutions to support patient involvement in the measurement of medical home-ness? Would this approach also guide medical groups to select the right infrastructure improvement projects for themselves and implement them quickly? This fits in nicely with the LEAN concept of “seeing the impact of what you do,” by getting smaller bits of feedback soon, combined with more comprehensive feedback over time.

Maybe a parallel iPhone Medical Home measurement application will surface …. see what you think.

Innovating for clients/recipients/patients at the Medicaid Medical Directors’ Learning Network

June 3rd, 2008 | Popularity: 17%
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Lee Partridge at Medicaid Medical Directors Learning Network

I was excited to present at the Medicaid Medical Directors’ Learning Network, invited by Amanda Brodt, MPP, from AcademyHealth, in St. Paul, MN. The Network is coordinated by Academy Health and Sponsored by the Agency for Healthcare Research and Quality.

I had not heard about the network before Amanda told me about it, so it was great to sit in on the round robin as these medical leaders shared their perspectives on serving Medicaid recipients across the United States. Their jobs are challenging to be sure, at the same time they bring a lot of energy and interest into serving well, which includes supporting the medical communities they work and practice in.

The topic of the session I attended was the Patient Centered Medical Home (PCMH) and how concepts are already being deployed in Medicaid populations. I was invited to give a private sector perspective and in that vain, gave a presentation entitled, “4 1/2 reasons why patients and families should be involved in their care, and 2 1/2 things you can do to help,” covering my experience implementing health information technology and visiting practices across the US over the past 7 months.

I expected to find an innovative group of physicians with a perspective on improving health care from a societal perspective, and I was not disappointed. Many of the States are grappling with the implementation of electronic health records locally and across large geographies – HIT is no longer the domain of a single health care organization. This means patient access is also a possibility across organizational and provider boundaries, which is really good news. Oregon, I believe, is now reimbursing for online visits within its program.

There was a comment made about the fact the Group Health has not experienced the same penetration of its online services in its contracted network, as demonstrated in this paper. I think this should be seen as a great opportunity, rather than an unchangeable reality, because the data indicates that patients at all levels of income and education are online and want to be involved in their care. The challenge is to outfit smaller practices with EHRs, and this is happening in places like New York and California, in what I think is a replicable model. At the same time, it was pointed out that the most vulnerable patients probably have the lowest level of access relative to their less vulnerable peers. It’s an excellent point to be made that populations with 40 % Internet penetration may benefit most from greater involvement.

Several of the Medical Directors expressed a belief that I share, which is that the leadership role is about enabling the best care, and awakening the desire on the part of all health professionals to be the best for their patients. I think this group and the programs they represent have the potential to support patient centered care for every patient in every system, and I like being in rooms where that’s the case, of course!

One thing I couldn’t find online is a web site (or blog :) ) describing this group’s activities. I know that they are all extremely busy – I think their communities, though, should be impressed with the work these physicians do on their behalf.

Thanks again to Amanda, AcademyHealth, AHRQ, and my sponsors, California Healthcare Foundation and Center for Information Therapy, for the conversation.

The RUC Speaks of Medical Home;Gathering Data on Hypertension;HealthPlan-Hospital Conflict in Arizona

May 13th, 2008 | Popularity: 55%
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May 6th through May 7th:

Voicethread; Zotero; Nice Summary of Medical Home from Deloitte

April 3rd, 2008 | Popularity: 82%
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April 1st through April 2nd:

Groundbreaking reimbursement agreement? ; Some patients don’t want PHRs; Role of the Federal Government in PHR Design

February 4th, 2008 | Popularity: 19%
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PCHIT links for January 30th through January 31st:

Medical Home in NY to include PHRs; PHRs in California – Not Yet?

January 30th, 2008 | Popularity: 21%
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PCHIT links for January 14th through January 29th:

How to talk to a doctor (?), Indiana and Patient-Centered Care, Patients want EHRs

December 6th, 2007 | Popularity: 20%
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PCHIT links for November 29th through December 4th:

San Franciso’s Medical Home, Steelcase’ Nurture, NYC recommendations for EHRs

November 27th, 2007 | Popularity: 20%
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PCHIT links for November 15th through November 21st:

23 seconds; PHR Time is Now; Pebble Project – Space Design in Health Care

November 14th, 2007 | Popularity: 31%
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PCHIT links for November 9th through November 13th:

World Usability Day, Washington DC patients’ experiences

November 7th, 2007 | Popularity: 13%
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PCHIT links for November 2nd through November 4th:

The “Adjust” from the Advisory Group: Part I

November 5th, 2007 | Popularity: 14%
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Eytan-Pchit-Advisory Group

PCHIT Advisory Group – Slides

This post is first in a series will summarize our status and input from our Advisory Group (Blogs are about a little information at a time). Both the Group and this audience are welcome to comment. Our goal is to make any adjustments necessary, now, and continually improve our process as we do this.

The summary comes in the form of an “A3″ document and a short set of slides. The slides are published here.

A reminder that an A3 document really just outlines a story. It’s probably best for this medium for me to discuss the work of each Advisory Group member (with the exception of Patricia Flatley Brennan, who could not be with us this first time) and the impact on adjusting our work.

To also keep this manageable, I’ll do it over the course of the week, one each day.

Michael Barr, MD, MBA, FACP: Michael, as Vice President of Practice Advisory and Improvement for the American College of Physicians, is leading the Medical Home work of the College. This includes establishing the “systemness” of the Medical Home, as well as understanding the economics of the Medical Home. He is working with payers to establish the benefit to patients and ability of Medical Home to address self-management goals. As currently devised, this model is most effective in practices where there are longitudinal relationships, such as primary care, but also in specialty care in certain circumstances. Several demonstration projects are set to begin in 2008. The College’s Center for Practice Innovation has been working with small practices to transform them, in line with Medical Home principles. The ACP is heavily involved in technology issues, at the level of some delivery systems. Finally, we are alerted to the publication of a white paper in the Annals of Internal Medicine on payment methodologies.

Adjustment: The impact of Medical Home discussions locally and nationally is very clear, and observations in PCHIT should be connected to Medical Home principles. Ted Eytan is presenting at the CPI conference in Washington, DC, on November 17 and will be spending time with CPI staff and practices as part of this involvement. The ACP white paper will be reviewed by us as well for implications for PCHIT.

Payers and Patient-Centered Primary Care; Google; Quality info in MA

October 30th, 2007 | Popularity: 12%
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PCHIT links for October 26th through October 27th: