Friday, August 21, 2009

Bringing Health (Reform) “Home” in New Hampshire

By Heather Staples

I was asked the following question by a UNH colleague the other day and thought that maybe I should share my response with everyone. The question was as follows:

“I am a patient of one of the practices in the Medical Home Pilot. What differences can I expect to see?”

The short answer is – it depends. There are no hard and fast rules about what exactly constitutes a Patient-Centered Medical Home. In fact, there are few absolutes for any health care process or treatment. That is why solving for the health care crisis is so challenging. In so many ways, treating a patient has been more reflective of the background and ethos of the clinician and the patient than of any specific protocol or evidence-base.

The Patient-Centered Medical Home movement and the new Recognition (aka Seal of Approval) process created by the National Commission for Quality Assurance (NCQA), are attempting to change this by specifying basic definitions and processes for managing patients. The degree to which practices meet these specifications translates into an NCQA Recognition Level of 1, 2 or 3.

Many of the practices in our Medical Home Pilot are being recognized at the highest level – Level 3 – such as Derry Medical Center, Lamprey Health Care in Newmarket, Westside Health Care in Franklin and Mid-State Health Center in Plymouth. Much of what they were already doing before the pilot began fell within what is recommended. However, they will all say that they have had to really re-invent themselves to meet the high benchmarks. The differences, from the patient’s perspective, may be subtle, but the experience should be increasingly satisfactory as practices improve over time.

Practices recognized as Medical Homes in NH, do the following things, at a minimum:

• Make sure patients can be seen the same day if needed;
• Track and actively improve upon wait times for visits;
• Proactively coordinate appointments, tests and procedures with specialists;
• Use electronic medical records and systems to track patients with chronic diseases and proactively manage them according to a care plan;
  • This proactive management means they review and act upon patient needs outside of regular visits and includes the creating reminders for preventive services, monitoring medications, scheduling tests in advance of visits and reaching out to patients to discuss their progress in recovery or management of their particular conditions.
  • Directly adhere to guidelines with strong evidence behind them to treat conditions;
• Work with patients on ways they can manage their condition independently by pointing them to resources, providing education and giving them copies of their care plan, including their results against that plan over time;
• Coordinate follow-up care with patients and families when they are discharged from a hospital;
• Use electronic prescribing to ensure that the right dosage and medications are administered and that any drug-to-drug interactions are avoided;
• Measure performance on quality, maintain a robust quality improvement program and assess patient, provider and staff satisfaction.

Transformation takes time, is subtle when viewed through a short-term lens, and requires continuous effort at improvement. The care our Medical Home sites provide is fundamentally different, and the lessons they can teach others about patient centeredness, quality and efficiency will hopefully lead us all to a reformed health care system with primary care as its foundation. For more information about the NH Medical Home Pilot, click here.

Tags: Citizens Health Initiative, healthcare, heather staples, medical home, pillar project, reform

This entry was posted on Friday, August 21st, 2009 at 9:31 am and is filed under Health Reform, Pillar Projects. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.