it’s the systems! l. gregory pawlson md, mph executive vice president ncqa core presentation
TRANSCRIPT
It’s the Systems! L. Gregory Pawlson MD, MPH
Executive Vice President NCQA
Core Presentation
2Physician Practice Connection and Patient Centered Medical Home
Why Focus on Systems? • IOM reports: “To Err is Human” and
“Crossing the Quality Chasm” – both reports provided substantial evidence on critical
importance of systems (including evidence from other areas (aviation)
• Evidence from a few RCT’s (measurement benchmarking and feedback) and studies with reasonable experimental design that systems appear to positively influence quality and efficiency
• Research showing variance on process outcome measures explained more by site/group than individual clinician
• Studies of Shortell, Wagner, Roblin and others on importance of structure and organization
3Physician Practice Connection and Patient Centered Medical Home
Focus on systems allows change from “blaming” individual clinicians for mistakes and
shortfalls to actions related to improving systems to facilitate
clinician success
4Physician Practice Connection and Patient Centered Medical Home
Wagner Model for Effective Prevention and Chronic Illness
Care
5Physician Practice Connection and Patient Centered Medical Home
Moving from models to practice
• Provide additional evidence of linkages between use of systems using structural measures, and both quality and efficiency process-outcome measures
• Development of reliable and valid tools for evaluating systems presence to use for both research and implementing practice change
• Create structural measures that are directly actionable and are free from major bias and confounds at physician office practice “microsystems” level – Sample size– Attribution– Need for risk adjustment
• Link adoption and use of systems to payment
6Physician Practice Connection and Patient Centered Medical Home
Patient Centered Medical Home
Delivery System Design
ClinicalInformationSystems
DecisionSupport
Self-ManagementSupport
What’s Included?(Infrastructure)
How Much Used?(Extent)
What Functions?(Implementation)
Evidenceand Scoring(Verification)
PPC
Wagner Chronic CareModel Community
Support
Overlap in Content of PPC-PCMH-CCMOverlap in Content of PPC-PCMH-CCM
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Office SystemsDecision Support
Information Technology Delivery System Design
Patient Support
Implementing and Evaluating PCMHImplementing and Evaluating PCMH
Inputs
Evaluation
Programs
Tools
PatientExperience
of CareMeasures
(CG-CAHPS)
Clinical Process &Outcome Measures
(inc overuse, resource use)(Recognition programs
and/or group/plan data)
Office Systems
Assessment (PPC)
Patient CenteredOngoing Care
IndividualClinician-Staff
Attitudes, behaviorsand proficiencies
Educational Support
Output
MOC(Boards)
Practice Evaluation Programs
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Linkage of PCMH to Reimbursement for “ongoing” care
Fee Schedule for Visits/Procedures
Payment per patient per month (or per year)
for level of “Patient Centered Medical Homeness”
Pay for Performance- Clinical and Patient Experience