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Annual Conference

2010 NCAHC Annual Conference

The NCAHC Annual Meeting- 2010 focused on the Patient Centered Medical Home(PCMH) and different implementations and applications in communities throughout North Carolina. A group of about 100 attendees from various aspects of North Carolina's health care communities convened at the Grandover Resort in Greensboro, NC. At this meeting, our guest speakers reviewed the history of PCMH in North Carolina, the present and the future. North Carolina health care is community based. Communities join together, gain consensus and focus on the most appropriate decisions in patient care. Several speakers offered insights into practice application of PCMH and suggestions on creating success. North Carolina's health care system is evolving, but understanding the need for a community-based approach will continue to drive success.

8:30 – 9:00 AM
Registration and Light Continental Breakfast: Exhibits Open
9:00 – 9:15 AM
Welcome & Program Overview
Bess Ramey –NCAHC, President
9:15 – 9:45 AM
Keynote Address:
Patient Centered Medical Home in NC and Improving Performance In Practice
Warren Newton, MD – Executive Associate Dean for Education at UNC School of Medicine

9:45 – 10:05 AM
The Primary Care Physician Shortage in NC and PCMH

R. W. "Chip" Watkins, MD – President of the NC Academy of Family Physicians
10:05 – 10:25 AM
Patient Centered Medical Home and the Role of Community - Based Clinical Pharmacist Services

Alison Eisenhart, PharmD, BCPS Specialty Pharmacy Clinical Manager, Kerr Health
10:25 - 10:45 AM

10:45 – 11:05
Cornerstone Health Care - Your Medical Home
Grace Terrell, MD, MMM, CPE, FACPE,FACP-– CEO, President Cornerstone Healthcare

11:05 – 11:25 AM
PCMH and the BCBSNC Blue Quality Physician Program
Larry Fox – Director, Network Quality Blue Cross and Blue Shield of NC
11:25 – 11:45 AM
Novant Healthcare and PCMH Implementation
Nan Holland –Sr. Director Clinical Excellence Novant Medical Group

11:45 – 1:00 PM
Lunch and presentation of the NCAHC’s Eagle Award

1:00 – 2:30 PM
Panel Discussion and Q & A
Chip Watkins MD
Alison Eisenhart, PharmD
Grace Terrell, MD
Larry Fox
Nan Holland

Panel Moderator: Joel Kostin, PhD

2:30 – 3:00 PM
Thank you to our sponsors Adjournment

Download the Conference Agenda Download the Conference Agenda

Warren Newton, MD - Executive Associate Dean for Education at UNC School of Medicine

Bio | Slides

Summary: Patient Centered Medical Home in NC and Improving Performance in Practice - Warren Newton, Executive Associate Dean for Education at UNC School of Medicine.

Dr. Newton, our keynote speaker, offered several perspectives on the history of patient centered medical home in North Carolina. Within his presentation he addressed various elements in improving performance in practices. He highlighted the continued need for Family Medicine; however, Family Medicine has to change. An approach that builds upon comprehensiveness and recognition that healthcare is a team effort where communication is critical to the successful patient management.

Chronic patient management rather than an individual disease state management is a much needed focus. With the advent of NCQA PPC-PCMH recognition program, this gave a handle to payers to reimburse for PCMH and allows the generation of systems to focus on care management.

The recognition of change is important, but it is just as important to focus on one area at a time and set milestones. A strategy may be to focus on access and measure satisfaction with access to care. A second focus may be on the management of chronic disease. For example, an objective measure of quality or a view of a population. Focus should be not only for the patients coming to the practice, but to those that are not coming in.

Community efforts in North Carolina help everyone and are critical to improvement in North Carolina. Examples of these efforts include NC Health Quality Alliance - the alignment of consistent quality measures across the state. A second effort is the I-3 Collaborative - the creation of Family Medicine residencies that provide hands on experiences with PCMH.

In summary, change is important, but take note to not lose the emphasis on the practice, the patient and new partners in health care. Keep a check on what patients think and bring new partners to the table to develop appropriate transitions in care. Improving quality is the first step in building a foundation in the future health care environment.

R. W. “Chip” Watkins, MD - President of the NC Academy of Family Physicians

Bio | Slides

Summary:Graduates of medical school are not flocking to primary care, and this shortage is projected to worsen over the next 10 years. The pay disparity between primary care practice and specialty care practices must be fixed if we want more residents to go into primary care. Eighty percent of the eastern part of NC is a Health Professional Shortage Area (HPSA), and doctors are becoming less and less willing to serve in these rural areas. What will happen when health care reform insures millions of people in both urban and rural areas? The North Carolina Academy of Family Practice (NCAFP) and the BCBS of NC Foundation has increased interest in family medicine with their program: “The Family Medicine Interest and Scholars Program.” Twelve family medicine scholars are picked each year to receive extensive mentorship under a master preceptor, as well as given the opportunity to attend state and national conferences. Successful completion of the program earns a scholarship and possible loan repayment assistance. The goals of this program are to encourage medical students to choose a career in family medicine, increase the number of students going into family practice residency programs, and increase the number of graduates who stay and practice family medicine in NC. In addition to serving patients in NC, each of these family practices has the estimated annual positive economic impact of one million dollars to the areas they serve. The PCMH seeks to: foster a continuous relationship with the primary care provider for both sickness and wellness; improve quality of care; increase patient and healthcare team satisfaction; improve primary care provider compensation; lower costs; and decrease emergency room utilization. For more effective and efficient treatment, the PCMH needs to be led by a physician, but also have a diverse team. With healthcare reform, the role of the PCMH and Accountable Care Organizations (ACO’s), as well as other models of care, will be vital. Our current system is wasteful, ineffective, and doesn’t reward prevention; therefore, it does not attract students to primary care. A more blended payment system is needed, including a combination of: fee for services, per member per month payments for PCMH, and pay for performance. The NC Academy of Family Practice (NCAFP) has helped develop and support the state’s Medicaid care management program, called Community Care of NC (CCNC). It is a nationally recognized program which relies heavily on PCMH, as well as population health management, community-based networks, and care management programs. At-risk patients are identified and cared for before high cost interventions are necessary. CCNC has saved NC hundreds of millions of dollars over the past 10 years.

Alison Eisenhart, PharmD, BCPS Specialty Pharmacy Clinical Manager, Kerr Health

Bio | Slides

Summary: Covered Medication Therapy Management Interventions. Pharmacists are playing an important role in Medication Therapy Management. MTM is a key component of the PCMH model. Pharmacists can assist patients in developing their Care Plan. Pharmacists can empower patients to improve appropriate, effective, safe and adherent medication use.There are multiple barriers to medication adherence. Pharmacists can assist in uncovering and addressing these.They can help to reduce medication errors and assist with managing adverse reactions. Positive outcome of interventions by clinical pharmacists has been proven. Three examples of successful programs - #1 in North Carolina: Community Care of North Carolina (CCNC) worked with asthmatics during a 2007 program that reduced hosp admission by approx 40% and ED visits by approx 16% . Total drug utilization increased but overall medical costs decreased. Resulted in a 15% improvement in quality of care. -#2-in Minnesota: BCBSMN. In a group of 285 pts there were 637 drug therapy problems discovered. This included 34% who needed additional treatment and 10% with noncompliance Pharmacy Interventions resulted in a 20% increase in Drug Costs but a reduction in overall medical costs of 31%. Avg savings/pt of approx $3,000 ROI for program was 12:1. -#3 In North Carolina: Asheville project. Coaching by pharmacists with Diabetic patients resulted in a 4:1 ROI Again drug spending increased but overall costs decreased. Note: a good resource for North Carolina seniors is the "Check Meds NC" program for conducting Medication Reviews.

Grace Terrell, MD, MMM, CPE, FACPE, FACP - CEO, President Cornerstone Healthcare

Bio | Slides

Summary: Dr. Terrell’s presentation focused on what Cornerstone Health Care has done and is doing to be “the model for physician healthcare in America” as well as “your Medical Home”. The Medical Home model includes care coordination and disease management which drives costs out of the hospital. Cornerstone includes widespread primary care, extended and weekend hours, a Medical Director, Quality Committee, NCQA certification, registry, integrated EMR and clinical pharmacy services. To help incorporate the Medical Home concept within their practices, their employees participate in 5 web-based lectures on the Medical Home. Once completed and tested on their knowledge, “Cornerstone Medical Home Professional” certificates are given to their employees. Dr. Terrell discussed how we need functioning Medical Homes to be effective. Networking and integration play a key role and theirs is “still a work in progress”.

Larry Fox - Director, Network Quality Blue Cross and Blue Shield of NC

Bio | Slides

Summary: Bridges to Excellence (BTE) was a three year pilot program from 2006-2009, which focused on enhancing quality of care. This program was developed together by BlueCross BlueShield of NC (BCBSNC) and the State Health Plan, and it was very successful in improving member health, long-term medical cost savings, and overall affordability. A key component of the program corresponded with the National Committee on Quality Assurance (NCQA) Physician Practice Connections (PPC), which recognizes the use of systematic processes and information technology to enhance quality of care. BTE was the forerunner to the BQPP that began in October of 2009. The BQPP offers incentives to primary care physicians in single or small group practices who meet quality standards, provide enhanced patient experiences, and promote increased administrative efficiency. Instead of offering bonus payouts as with the BTE program, the BQPP offers higher reimbursement levels within the standard physician contract fee schedules. These fee schedules are increased for evaluation management codes, and payment is not capitated. Reimbursement is based on a point system that is heavily weighted towards quality of care, and physicians can earn additional points by precepting three medical students a year. Nurse practitioners and physician assistants are currently not offered a BQPP designation, but they will receive the higher reimbursement in one of these practices since the BQPP assessment is offered and awarded at the group level. Phase I of this program incorporates provider performance in: quality of care, administrative efficiency, and patient experience. Within Phase I, Patient Centered Medical Home (PCMH) and PPC recognition, electronic prescribing and claims submission, and cultural competency training are all mandatory. Phase II of this program will address the cost and efficiency of care. During this phase, BCBSNC will be recalibrating and increasing certain standards, and new recognitions will also become available. BCBSNC Quality Management Consultants (QMC’s) have been trained by NCQA to provide support for physician practices, and providers should contact their assigned QMC if they are interested in the BQPP. Providers can learn more about this program online at the BCBSNC website, where they can also determine their eligibility, score themselves, and apply for the program. The state of North Carolina has the greatest number of NCQA accredited physicians in the country, and feedback was sought from key physician groups and leaders in the community in the development of the BQPP. In general, reimbursement models must change to accept more risk and eliminate avoidable cost, but with there will be the potential for more reimbursement.

Nan Holland - Sr. Director Clinical Excellence Novant Medical Group

Bio | Slides

Summary: PCMH implementation has been a long journey. Our history includes some helpful background to implementing PCMH. W obtained a grant focused on the Medicare Demo Project. We also have were able to have a beta test of the PCMH by Novant’s work on the Diabetes and Heart/Stroke Recognition Program where we learned valuable lessons. With the CMS Medicare fee for service demo project, there were 10 other groups in the country involved. We focused on managing cost, improving quality and really focusing on our patients that were high utilizers of services. As a result of our work, we had a 38% reduction in admissions to hospitals with a strong focus on improving the care of CHF patients. But, we also realized to have a truly effective Medicare demo program, we need to involve the provider community. As a result, we engaged 5 pharmacists to review high risk drugs for recently discharged Novant patients. For example, we focused on Coumadin users, those patients on 5 or more medications and/or patients utilizing drugs on the Beers lists. These interventions contributed to forming a very valuable relationship with patients and improved customer feedback/patient care. In 2006, Novant received a grant from the Health & Wellness trust to support additional work with the diabetic patient to include topics such as obesityand disparate income. We also wanted to include non Novant patients in our communities. Our reach was broader and more community focused. We also understand we need to focus on electronic systems within the network and within the physician office. It is a big challenge but critical to our efficiency as a system. It will help us better managed care and control health care cost. We are ranked 19 in industrialized nations for healthcare quality. We need to remember it’s a long journey and it’s about the whole office. We need transparency; we need to share customer satisfaction feedback. In is integral that the healthcare provider, the payer and the patient must all work together.

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