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Helping health centers reach PCHH certification.

Colorado Community Health Network (CCHN) provides technical assistance to Colorado Community Health Centers (CHCs) as well as other Primary Care Associations (PCA) who are part of the Center for Medicaid and Medicare Services (CMS) Advanced Primary Care Practice Demonstration (APCP) Project. CCHN supports these health center's Patient-Centered Health Home (PCHH) transformation goals. The CHCs provide a health care home to more than 600,000 community members--one in ten people in Colorado--from 58 of the state's 64 counties. CCHN's goal is for each CHC to implement the PCHH model and obtain NCQA PCHH recognition, thereby achieving improvements in patient health outcomes, patient experience, staff satisfaction, and cost savings. CCHN also provides technical assistance.

Fifty five percent of CHCs have received PCHH recognition from the National Committee of Quality Assurance (NCQA), the Joint Commission, or the Accreditation Association for Ambulatory Health Care. By 2015, it is CCHN's goal that 100% of CHCs will have achieved NCQA recognition. CCHN maintains that by 2013, 100% of CHCs who do not have NCQA recognition will be actively pursuing it, and that 100% will have started the medical home transformation process. To date, 88% of CHCs have started medical home transformation and are actively pursuing NCQA recognition.

PCHH teams from CCHN have been established at the CHCs and are actively implementing PCHH transformation. CHCs who have successfully completed their NCQA PCHH applications continue to use Quality Improvement (QI) teams to sustain and spread PCHH transformation--demonstrating that there is a movement to not only initiate, but to sustain transformation efforts. The capacity of these teams continues to grow, enhanced through targeted workshops with expert speakers, train-the-trainer programs, action planning tools, and the integration of performance tracking and data into staff meetings.

Colorado's CHCs have embraced the PCHH model of their own volition. Through national initiatives such as the Health Resources and Services Administration Supplemental Funding and the Center for Medicare Advanced Primary Care Demonstration Project, some of Colorado's CHCs have received funds to augment and enhance their PCHH transformation efforts.

CCHN's approach is to ensure transformation at the health center will be focused on the individual needs of the patient, and encourage patient ownership of their health, as well as encouraging self-management. CCHN's goal is to improve patient experience with health center services, and to improve not only health outcomes but also operational, business, and workforce outcomes that will support sustainability of the PCHH model. In addition to this, increased health center capacity to assess and meet community needs as well as education of payers, legislators, and other QI organizations about the benefits of the PCHH concept, remains a priority.

As Colorado's PCA, CCHN offers a variety of technical assistance, much of which is tailored to the individual needs of the CHC. Participation in the Safety Net Medical Home Initiative (SNMHI), a project funded by Qualis Health, the MacColl Center for Health Care Innovation at the Group Health Research Institute, and the Commonwealth Fund, provided CCHN with a unique perspective in PCHH transformation. In the lessons learned through the SNMHI, CCHN has chosen to use the eight SNMHI change concepts as the framework for PCHH spread and sustainment. Change concepts are used to stimulate actionable steps that over time lead to improvement.

The core foundational change concepts that are essential to establishing an advanced patient-centered health home are engaged leadership, QI strategy, empanelment, and continuous and team-based healing relationships. Examples of these are as follows:

Engaged leadership means that leaders at CHCs are visible, supportive, and directly involved. An Engaged Leadership will ensure protected time for providers and care teams, establish and support a QI team within the CHC, identify specific strategies for QI, and ensure that the CHC's values are centered upon the PCHH model.

The QI strategy is a formal model for Quality Improvement. The CHC will establish and monitor metrics, utilize patient feedback, and involve patients, providers, and care teams in QI activities. Many of our CHCs have used the LEAN Six Sigma Methodology to transform and improve workflow, staff roles and responsibilities.

Empanelment indicates that the patient has been assigned to a specific provider. The PCHH model is dependent, among other things, upon the relationship between the patient and the provider. This method has demonstrated higher patient satisfaction, enhanced continuity of care, and increased patient trust. Each care team within the PCHH model has a unique panel of patients with whom they work.

Continuous and team-based healing relationships means patients are connected to care teams, which maintain and enhance the patient-provider relationship. Each care team has defined their roles, tasks, and communication. Tasks are assigned to members of the care team as befitting of their skill, professional experience, and interest. Staff is trained and cross-trained and these team roles are transparent to patients. It is most effective when team members are working to the top of their licensure.

The technical assistance CCHN offers also includes document review, readiness assessment review, and gap analysis documents to identify areas of improvement. Applications from sites who have received PCHH recognition are shared transparently with other health centers and editable policy templates have been developed. Policy review is available and utilized, during which time the site's policies are reviewed to ensure compliance with application requirements.

Training resources for CHC staff include presentations and materials providing an overview of PCHH transformation, as well as workshops focused upon specific change concepts. CCHN has encouraged development of a culture of data that includes a statewide plan to collect, analyze, and share patient experience data and clinical outcomes data. This has in turn facilitated a best practices forum and provides a qualitative understanding of progress and need.

CCHN hosts monthly coaching and conference calls around the use of data to drive quality improvement processes, track the impact of improvements, and monitor sustainability. These conference calls with CHC staff serve to maintain momentum; the topics of which range from: discussions of transformation efforts, facilitation of a discussion forum for CHCs to voice progress and concerns, expert speakers, and topics suggested by the CHCs themselves. Through this development of learning communities, CHC staff is continuously involved in QI work, combatting change fatigue, and sustaining a communal support structure. Peer-to-peer networking and relationships between the CHCs are fostered by CCHN through workshops, presentations, and learning collaboratives.

Future transformation and spread efforts are geared primarily toward the sustainability of PCHH transformation. CCHN will work with CHCs on the integration of special populations and social determinants of health into QI activities and ensure needs are addressed through PCHH transformation. CCHN will continue to assist health centers with implementation of a statewide method of patient experience reporting, identify and share best practices, and host additional workshops.

Undertaking the PCHH transformation efforts requires commitment on many levels, from providers, to health center staff, to leaders, and the process is not without its challenges. The greatest challenge CHCs have experienced while seeking recognition is staff and leadership turnover. However, CCHN has continued to provide support to the CHC in the form of trainings, site visits, conference calls, and as requested. CCHN has dedicated PCHH coaches who will work with QI staff to address these challenges as much as possible. The returns on PCHH certification are magnanimous and evidence themselves in not only the tangible results of patient welfare, but also in terms of cost savings

For more information please contact Victoria Gersuk.

By Victoria Gersuk, Quality Initiatives Coordinator at Colorado Community Health Network
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Author:Gersuk, Victoria
Publication:Migrant Health Newsline
Geographic Code:1U8CO
Date:Aug 1, 2013
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