Medical Home Monitor
Medical Home Monitor
February 7, 2011
Vol. III, No. 19

Medical Home Monitor Archives

In This Issue:

  1. Q&A: Patient Benchmarks, Ideal ACOs
  2. New NCQA Medical Home Standards
  3. New Chart: Top Points In Care for Patient Education
  4. Podcast: Redesigning the Physician Practice
  5. Primary Care Capacity in 2014
  6. E-Survey: Accountable Care Organizations
  7. Benchmarks: Reducing Readmissions in 2010
  8. Editor's Pick

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Medical Home Q&A's:
Patient Benchmarks,
The Ideal ACO

Medical Home Monitor

The Ideal ACO

Q: There are so many models out there for ACOs — physician-owned, hospital-owned, health plan developed. Which ACO model has the best chance of succeeding at the goals of improving the value of healthcare and the controlling or reducing costs?
A: Physician-driven organizations, physician-managed and physician-led organizations are the ones that will likely succeed in this effort. The organization has to be developed independently and then the organization should review strategic alliances and other types of strategic relationships, which can be collaborative in nature and provide win/win scenarios, but the physicians need to be self-governed and self-managed and need to fully understand how to operate and run their organization in order to be successful.

Jeffrey Ruggiero, Esq., partner in the law firm of Arnold & Porter, who is advising the Queens County Medical Society on its ACO development.

For more ideas to maximize ACO success, please visit:

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Benchmarking Patient Outcomes

Q: How are you benchmarking your patient outcomes compared to other nurse triage call centers?

A: We try to find call centers most like ours. We try to measure against call centers that are of the same size. We compare against other MCO call centers. We also look at some national benchmarking and at regular call centers because that’s how we benchmarked abandon rates based on the number of calls. When we looked at call triage centers, usually the benchmarking was anything less than 5 percent abandon rate. Because what you don’t want to do is go into a regular QVC-like call center, which will have a 1 to 2 percent abandon rate, because you’re actually going to be on the call a little bit longer than even taking orders. You have to be very cautious about what you do benchmark yourself. We try to compare against other call centers nationally. We look at other national benchmarking standard companies and then benchmark our abandon rates against those.

Patricia Curtis, director of operations for clinical care services for Optima Health.

For more details on nurse advice lines, please visit:

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NCQA to Medical Homes: Make It About the Patient
Updated standards for patient-centered medical homes (PCMH) from the National Committee for Quality Assurance (NCQA) direct practices to organize care according to patients’ preferences and needs. The new standards, referred to as PCMH 2011, call on medical practices to be more patient-centered and reinforce federal 'meaningful use' incentives for primary care practices to adopt health IT.

To an unprecedented degree, PCMH 2011 directs practices to organize care according to patients’ preferences and needs. Standards emphasize access to care during and after office hours, and managing care in collaboration with patients and families. Other aspects of patient-centeredness include providing services in patients’ preferred languages, helping patients with self-care and facilitating patient access to community resources.

To support patient-centered care for children, PCMH 2011 standards include parental decision-making, teen privacy and guardianship. Standards also cover communication between medical facilities about newborns’ lab results and guidelines for planning the transition from pediatric to adult care.

What’s new for 2011:

Beyond their more patient-centered focus, PCMH 2011 standards include the following:

  • An emphasis on patient feedback that supports what is widely known as the “triple aim” (improving quality, containing costs and enhancing patient experience). NCQA is collaborating with the AHRQ to develop a medical home version of the Consumer Assessment of Healthcare Providers and Systems (CAHPS) Clinician & Group Survey, a widely used evaluation of patient experience. NCQA expects to release CAHPS for medical homes in the second half of 2011.
  • Starting in January 2012, practices may receive additional NCQA distinction by voluntarily reporting patient experience data.
  • Support for health IT: federal meaningful use language is embedded in PCMH 2011 evaluation standards, reinforcing incentives for practices to use health IT to improve quality. The standards’ alignment with meaningful use means that practices that meet PCMH 2011 requirements will be well prepared to qualify for meaningful use, and vice versa.

According to the NCQA, the new 2011 standards debut the next generation of the NCQA recognition program that designates high-quality primary care practices as PCMHs. As of the end of 2010, almost 7,700 clinicians at more than 1,500 sites across America used NCQA standards as a roadmap to become high-quality primary care practices and receive NCQA Recognition as PCMHs.

Download PCMH 2011 standards free of charge at

For more information, please visit:

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New Chart: Top Points In Care for Patient Education
Healthcare organizations are learning that an investment in patient and member education is money well spent. We wanted to find out at which points in care patient education is conducted.

View the chart at:

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HealthSounds Podcast: Redesigning the Physician Practice for Improved Efficiency and Increased Revenue
In the face of healthcare reform and new models of care delivery such as the patient-centered medical home, primary care physicians don't have to fly solo anymore, advises Dr. David Eitrheim, a family physician with the Mayo Clinic Health System in Wisconsin. Dr. Eitrheim described how his practice's team-based approach has changed the nature of the patient visit as well as the nurses' workload, and provides the secret to a productive patient visit.

To listen to this HIN podcast, please visit:

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8 States Face Primary Care Capacity Challenges in 2014

A new study published in the New England Journal of Medicine finds that many of the states that will experience the largest Medicaid expansions under the Patient Protection and Accountable Care Act (PPACA) unfortunately also have the weakest primary care capacity.

Researchers determined that eight states – Oklahoma, Georgia, Texas, Louisiana, Arkansas, Nevada, North Carolina and Kentucky — have especially weak primary care infrastructure in the face of large Medicaid expansions, and 17 other states could also face substantial challenges. The interstate differences underscore the importance of state-specific and local plans to address the capacity and access issues.

The study was conducted by researchers at the George Washington University School of Public Health and Health Services and supported by the Geiger Gibson/ RCHN Community Health Foundation Research Collaborative. Using estimates of the size of planned Medicaid expansions and current primary care capacity, the researchers computed rankings across the 50 states and the District of Columbia. The group examined primary care capacity challenges that states will face when Medicaid eligibility expands in 2014 under the PPACA.

PPACA expands Medicaid’s income eligibility level for non-elderly adults up to 133 percent of the federal poverty line (about $30,000 for a family of four) across the nation in 2014. The authors explain that coverage will expand substantially in those states with restrictive Medicaid eligibility requirements and high uninsurance rates. However, since many of those states have limited primary care capacity, this will create a gap between the demand for medical care by those who are newly insured and the current supply of physicians, nurse practitioners and physician assistants in each state.

“Community health centers play a key role in addressing the nation’s primary care needs,” said Julio Bellber, president and CEO of the RCHN Community Health Foundation, which helped sponsor this study, “It is fortunate that health reform makes a major new investment in health centers, which are poised to expand substantially to improve access in underserved communities.”

For more information, please visit:

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HIN Survey of the Month: Accountable Care Organizations in 2011
On board with ACOs, on the fence or simply in the dark? To learn more about this emerging trend and receive valuable benchmarks on ACO awareness and adoption from more than 50 healthcare organizations, complete HIN's survey on accountable care by February 11. Your responses will be kept confidential.

Complete the survey by visiting:

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Reducing Reamissions in 2010
This white paper summarizes the top strategies, program components, staffing requirements, targeted conditions and populations and results from readmission reduction efforts by 90 healthcare organizations in response to the Healthcare Intelligence Network’s second annual Reducing Readmissions e-survey conducted in December 2010.

To download this complimentary white paper, please visit:

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EDITOR'S PICK: Save 10% on This Week's Medical Home Resource

2011 Performance Benchmarks in Telehealth & Telemedicine

2011 Performance Benchmarks in Telehealth & Telemedicine is packed with actionable new information from 111 healthcare organizations on their utilization of telehealth & telemedicine. This 60-page resource documents trends and metrics on current and planned telehealth and telemedicine initiatives and includes a year-over-year comparison of telehealth trends from 2009 to 2010.

The 2011 edition also provides metrics and measurements on the following:

  • The top non-clinical and clinical applications for telehealth;
  • Emergence of telephonic nurse advice lines, with commentary from WellPoint and Optima Health on the impact of telephonic health advice lines on health utilization;
  • Telehealth tools available to patients and health plan members;
  • A closer look at remote monitoring — health conditions and activities monitored as well as results achieved with remote monitoring — and how Geisinger Health Plan uses remote monitoring for target populations;
  • How respondents will take advantage of telehealth provisions contained in PPACA;
  • More detail on the impact of telehealth on patient compliance, medication adherence, healthcare access, office visits, hospitalizations, ER visits, bed days, readmissions, and much more;
  • The most successful applications of telehealth;
  • Sector-specific analysis of telehealth use and impact by health plans and hospitals;
and much more.

Use ordering code MHMP to save 10 percent on this special report by visiting:

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Contact HIN:
Editor: Patricia Donovan,;
Publisher: Melanie Matthews,;

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