One more cup please! (CPCI, Part 3)

Today is the third part of a series looking at the Comprehensive Primary Care Initiative. See Monday and Wednesday for parts 1 and 2.

The CPCI will test two models simultaneously: a service delivery model and a payment model.  For now, we'll look only at the payment model:

Payment Model. The payment model includes a monthly care management fee paid to the selected primary care practices on behalf of their fee-for-service Medicare beneficiaries and, in years 2-4 of the initiative, the potential to share in any savings to the Medicare program. Practices will also receive compensation from other payers participating in the initiative, including private insurance companies and other health plans, which will allow them to integrate multi-payer funding streams to strengthen their capacity to implement practice-wide quality improvement.

Of particular importance here are two things. The first is the care management fee. Do you think PCPs are motivated to take on care coordination? You bet they are! The second is the inclusion of private insurance companies. For those who do little by way of Medicare volume, it's essential to understand that health care reform is not about Medicare alone; it only starts there. The transformation is ubiquitous; it's for every patient, every provider and every payer.

Elsewhere, we'll learn about bundled payments, a new approach to reimbursement that is centered around coordinated care. Coordinated care and the patient-centered medical home are inextricably linked within the CPCI. So we must foresee that, as noted above, the service model and the payment model go hand in hand. Change one and you change the other. Are you preparing for the obsolescence of fee-for-service direct billing? Are you ready to participate in team-based care? Getting ready means EHRs, communications and showing your value as a health care provider to the primary care physicians in your patient catchment area. This is not about stimulus money; it's about scoring winning goals in the new health care game.

Alistair Jackson, M.Ed.
Jim Grue, O.D.  

More coffee anyone? (CPCI, Part 2)

We told you last day that we now know the names and locations of 500 primary care practices in seven states involved in the Comprehensive Primary Care Initiative. Understanding the significance of this announcement is tied to knowing something about the purpose of the initiative. Below, I've taken only two of six things the PCPs are being incentivized to do:

Deliver Preventive Care: Primary care practices will be able to proactively assess their patients to determine their needs and provide appropriate and timely preventive care. 

Coordinate Care Across the Medical Neighborhood: Primary care is the first point of contact for many patients, and takes the lead in coordinating care as the center of patients’ experiences with medical care. Under this initiative, primary care doctors and nurses will work together and with a patient’s other health care providers and the patient to make decisions as a team. Access to and meaningful use of electronic health records should be used to support these efforts.

The first point emphasizes preventive care, which Optometry in particular is all about. Prevention is a major tenet of healthcare reform because it lowers cost. Therefore, we should have no doubt that healthcare reform is relevant to Optometry.

Second, "other health care providers". That also includes you ... but provided you are plugged into the meaningful use of electronic health records. 

EHRs are not an end in themselves. You gather data in EHRs in order to share it. You share it in order to participate. Participate in what? Coordinated care. Why? As we'll see next day, coordinated care will become the predominant payment model. Without the ability to participate in team-based care delivery, you will lose access to your patients.

Alistair Jackson, M.Ed.
Jim Grue, O.D.

Good morning! Coffee anyone? (CPCI, Part 1)

On August 4th, we published a post entitled, "PCPs, your new best friends". We wrote about a health care pilot program called the Comprehensive Primary Care Initiative and its importance for eye care. Last week, while many of us were either taking part in or traveling to Vision Expo West, something significant happened: CMS published the names and addresses of every participating PCP practice.

There are 500 primary care practices participating in the CPC initiative, representing 2,144 providers serving an estimated 313,000 Medicare beneficiaries. 

Arkansas: Statewide
66 Primary Care Practices | 228 Providers | 4 Payers
Estimated 51,000 Beneficiaries Served 

Colorado: Statewide
73 Primary Care Practices | 335 Providers | 9 Payers
Estimated 41,000 Beneficiaries Served 

New Jersey: Statewide
73 Primary Care Practices | 252 Providers | 5 Payers
Estimated 42,000 Beneficiaries Served 

New York: Capital District-Hudson Valley Region
75 Primary Care Practices | 286 Providers | 6 Payers
Estimated 40,500 Beneficiaries Served 

Ohio & Kentucky: Cincinnati-Dayton Region
75 Primary Care Practices | 261 Providers | 10 Payers
Estimated 44,500 Beneficiaries Served 

Oklahoma: Greater Tulsa Region
68 Primary Care Practices | 265 Providers | 3 Payers
Estimated 45,000 Beneficiaries Served 

Oregon: Statewide
70 Primary Care Practices | 517 Providers | 6 Payers
Estimated 49,000 Beneficiaries Served

Why is this so significant? Because it spells out for us in clear terms where the transformation of health care is taking us. Join us next day for more details. Or, if you can't wait to learn more, read here.

Alistair Jackson, M.Ed.
Jim Grue, O.D.

A perfect scenario ... perfectly bad!

A friend phoned me today with a question about medical homes and coordinated care. After hearing his scenario, I responded, "Perfect!" Unfortunately, it was a perfectly bad scenario that describes exactly how unprepared optometrists will start losing access to their own patients. I'm sorry to say it, here's the bad news ... then some good news.

An optometrist sees a patient for a regular eye health exam, does the usual diagnostic testing, and then some, and determines the patient needs to see an ophthalmologist. The patient visits the ophthalmologist who happens to be involved in a care team through an ACO or medical home. Although the patient had chosen the optometrist for the initial visit, the ongoing care is now turned over to the care coordinator whose job it is to coordinate all the care of the patient. The care coordinator schedules a follow-up visit with the care team's optometrist instead of going back to the referring optometrist.

Yes, we can hear the outcry. Unfair. Wrong. Bad business. And no doubt there's some merit to those cries. It'll happen nevertheless. The reason may constitute an unfair betrayal but it may also be legitimate. 

This scenario sits in the middle ground between legislation and reality. The legislation says patients may choose their Medicare provider but the reality is they'll often just go along with the recommendation of their doctor's office. Remember that medical homes and care coordinators are incentivized, so some will be rather convincing about the reasons to see team doctors. Also remember that there may be legitimate new reasons to have patients switch specialty providers.

What if the referring optometrist does not use EHRs? Or, the O.D. has EHRs but doesn't use them for communications. The optometrist may know nothing about care teams or medical homes, so hasn't attempted to connect with the local provider network. All of these are reasons a provider cannot be included - doesn't qualify - when it comes to team delivery of care or bundled payments.

On the other hand, let's say that optometrist is you, and you have implemented not only a certified EHR but also DIRECT communications capabilities. Admittedly, in this case you'd have been proactive enough not to end up here in the first place. But supposing you did somehow, you'd now be in a position to step in and prove value to that care team, perhaps even add more value than the incumbent optometrist. 

Do you have questions or scenarios for which you'd like to see an explanation? Submit them through the Comments and Reactions area below this post, or email us. We'll be happy to respond.

Alistair Jackson, M.Ed.

ACOs, Unlikely Homes for Medical Homes - Part 3 of 3

Continued … see part 1 of this discussion, published Monday, August 20

OK, so you’re a skeptic and the numbers from last day look just too good to be true. Let’s take a more conservative view. While the above scenarios are supported by actual clinical tests and situations, let’s suppose they are best-case scenarios and therefore extreme. If the savings were only 15% of the above, the medical home provider could still see over $100,000. Let’s say then that the medical home decides to keep 50% of the shared savings and divide the other 50% among the other team members. This means adding only $50,000 to the income of the primary care physician. Current average PCP income = $135,000. Add $75,000 net for care coordination. Add $50,000 from shared savings. $260,000.  We now have a program that, even when viewed from the most conservative vantage point, is structured to bring the income of the primary care physician from $135,000 to $260,000. In essence, the program is designed to double the income of primary care physicians who decide to participate in medical home style delivery and reimbursement systems.  

We can start to understand now why payers are willing to work together to fund the coordination of care through pilot programs like the Comprehensive Primary Care Initiative (CPCI). We can also see why 200 primary care physicians attended the first organizational meeting of the CPCI in one small city in Ohio.  And we can also understand why ACOs would not embrace this process or why, in fact, they would put as many barriers as possible in place to prevent such a system from being implemented. As we have stated already, the regulations by which ACOs can be established are so complex that almost all ACOs are large health systems. These health systems primarily generate their income from specialty care while the savings are being generated through primary care, coordinated care and the medical home.  

It is clear to see that the maximum cost savings, and the biggest boost to improving quality of care is going to work when the medical home is a separate business entity from the health system.  Predictably, we would not expect to see ACOs embrace the medical home.  On the other hand, we would expect to see – and are seeing, in fact – huge popularity of the CPCI among independent primary care physicians. ACOs are resisting expansion of the medical home even publishing negative studies to resist the concept from being established as part of the new delivery system.  

Jim Grue, O.D.

Alistair Jackson, M.Ed.

ACOs, Unlikely Homes for Medical Homes - Part 2 of 3

Continued … see part 1 of this discussion, published Monday, August 20

When a new medical home is formed, a rather complex set of formulae is used to predict the cost of care in the traditional delivery system. Going forward, the actual cost of coordinated care is tracked, so eventually it is known whether the coordinated care or the traditional care was more expensive. The hypothesis is that coordinated care is able to deliver better quality at a lower cost, so let’s assume that the coordinated care, in fact, ends up less expensive. At least in these early years, the formula for shared savings dictates that the medical home gets paid 85% of the savings.  Yes, almost the complete amount saved through the medical home’s coordinated care approach is given back to the medical home.  This will no doubt change over time; a big return is intentionally structured as a major incentive in order to convert quickly to the new model, a similar approach to the EHRs incentive program – money speeds adoption.  

Now let’s look at the savings possible. Almost all providers, new to the medical home concept, are concerned that the primary care physician will act as a gatekeeper, preventing them from seeing the patient or doing the required tests. In reality, nothing could be further from the truth, which we’ll see below. Cost savings are not generated by reducing or eliminating necessary care. In fact, the maximum savings are generated when the coordinator ensures that the patient receives the very best care. It is difficult to think of an example where poor care is less expensive than the best care. If a patient isn’t properly diagnosed and treated then invariably there are more visits to eventually get it right. If the best surgery is not performed, the result is simply more after-care at higher expense.  So the first mandate of a care coordinator is to make sure all care received by every patient is the best available. This alone will generate savings.  

The next step is to eliminate duplication of care that doesn’t result in better outcomes. A familiar scenario will serve us well here:  in eye care, if an optometrist does specialty tests then has to refer the patient to an ophthalmologist, in almost all cases, the ophthalmologist repeats every specialized test.  In the case of ODs and retinal specialists co-following patients, both typically see the patient on an ongoing basis and both continue to perform the same specialty tests. This happens right now because the two specialists get to decide what tests they want, not to mention that it’s in the economic interests of both to perform the tests. If we were in a position to coordinate the care of this patient, we’d know exactly how to increase those shared savings! We’d make sure the appropriate tests were being done but by one provider only and we’d have the results shared by all providers seeing the patient. The only time a test would need to be repeated would be if there was a question of its accuracy, which then gives the coordinator the incentive to ensure that the office that performs the tests is the one that proves over time its ability to get the most consistent, accurate results. 

Scenarios like this one are replicated in different ways throughout medicine every day. So, the care coordinator has two simple tasks that create huge savings: ensure every patient receives the best available care at every visit; identify and reduce or eliminate redundant costs which do not improve the quality of care.

Studies have shown that these two things alone have the potential to reduce the total cost of care by as much as 30%. Those are big dollar amounts. When we consider that the cost of health care in the United States is approximately $7,000 per person per year, we start to see the potential shared savings. Using this figure, a medical home coordinating the care of 500 patients is coordinating $3.5 million dollars of care per year. If 30% can indeed be saved, the potential savings is over $1 million. The 85% rule tells us that the medical home could receive over $850,000 from shared savings. These are staggering numbers for PCPs whose average annual earnings are currently $135,000.  Do we dare think PCPs are not all over this opportunity? If in doubt, check out the website of the American Academy of Family Physicians and see what they’re doing about the PCMH initiative.

To be continued …

Jim Grue, O.D.

Alistair Jackson, M.Ed.

ACOs, Unlikely Homes for Medical Homes - Part 1 of 3

In the early days of Accountable Care Organizations, it seemed they would be the natural resting place for the patient-centered medical home (PCMH). That thinking has changed. While it appears ACOs may use some medical home concepts, there is growing doubt about the compatibility of the two entities. Let’s understand why. 

Why would ACOs would be resistant to medical homes?  First, the medical home concept promotes coordinated care and shared savings, core values in health care reform. Second and fundamentally, health care reform means a change in the financial positioning of primary care versus specialty care. In the current fee-for-service system, some would contest, primary care is underpaid while specialty care is overpaid. The balance is shifted by the core tenets of health care reform so that primary care becomes better paid, basically at the expense of specialty care. And hospitals and health systems, where ACOs typically reside, are predominantly specialist-oriented.

For the sake of simplicity in the following discussion, we’ll be viewing primary care and specialty care in separate business contexts even though we know that within hospitals, health systems and ACOs the two exist under one roof.

To begin, let’s use precise figures from the Ohio Comprehensive Primary Care Initiative (CPCI); it is modeled as a medical home and we know the numbers. Reimbursement for primary care physicians through the medical home model involves two key changes: the first is that the medical home gets paid a separate fee for coordinating the care of patients; secondly, the medical home gets to share in the savings created as a result of care coordination.  

What is the effect on PCP income of getting paid for coordinating the care of patients? Let’s assume that the office of a primary care physician can coordinate the care of 500 patients. This requires the medical home to hire an additional staff person at a cost of $50,000.  The CPCI in Ohio is paying $22.50 per head per month for care coordination. This generates $11,500 per month, or $138,000 per year, in additional revenue to the medical home. After the cost of the additional staff person, the new revenue leaves $88,000 for organizational profit.  Supposing that the medical home provider has some miscellaneous expenses, we’ll allocate $75,000 toward profit. The average income for a primary care physician in the USA today is $135,000.  Therefore, by becoming a medical home, a primary care physician practice increases its income to about $210,000.  So we can see how becoming a medical home, versus remaining simply an independent PCP practice, can significantly increase the income of the primary care physician. Yet, we haven’t begun to consider the real income-increasing potential of a medical home: shared savings accounts. This is where it gets interesting.

To be continued …

Jim Grue, O.D.

Alistair Jackson, M.Ed.

PCPs, your new best friends!

No matter how large or small your professional network, it's time to improve communications with the Primary Care Physicians in your community. Why? For years, healthcare in the USA has been specialty-centric. That is, in the M.D. world, specialties have made a lot more money than primary care. Healthcare Reform is changing that balance of power ... and payment.

Perhaps you've already read our comments about the Comprehensive Primary Care Initiative, even noticed or attended meetings in your state or city. The bottom line is that PCPs are being heavily incented to take on care coordination and to develop their practices as medical homes or medical communities. Given that care coordinators will take over the total care of the patient, we need to understand that PCPs are being placed at the power core of reformed healthcare. Not only will they coordinate every aspect of patient care, they will assemble the care team. Primary Care Physicians will play a key role in choosing the specialty providers who are able and available locally to most efficiently get the job done. Those team doctors (specialists) will need to be both available and valuable. So, when it comes to the eye care needs of the patient, will the PCP's eye care provider of choice be you?

We'd like to suggest that, more often than not, the Eye Care Practioner (ECP) of choice will be someone within the PCP's network, such as employee of the local hospital where the primary care physician already has admitting privileges and working relationships. Why? Expediency. 

If that seems discouraging, it's probably time to think hard about being an independent eye care provider. No, this is not simply the same old same old. It's not the way it's always been. In years gone by when patients chose you based on your local reputation, there was no highly incented and highly paid care coordinator in the local doctor's office taking over the scheduling of their eye care visits. 

The new realities of health care reform call for a proactive stance. YOU must step up and be counted. As we've seen in the last six posts, you have to be in the EHR game, you have to be ready for communications, you have to offer your value-add services to the local PCPs with whom you want to work. 

We'll alert you, prod you, raise the red flag, advise and help you. In the end, you have to get busy at the grass-roots level and make things happen.

Alistair Jackson, M.Ed.

Jim Grue, O.D.

Beyond EHRs - Phase 5

Today's post focuses on the last of a 5-phase continuum. If you're joining the discussion today for the first time, please refer back to our July 20th post for the big-picture overview.

At last, the end game: phase 5, Get paid through a bundled payment system. From the early days of health care reform we knew that fee-for-service reimbursement would yield to pay-for-performance. At that time, the bundled payment angle was not evident. We suspect that it's still not generally understood. Let us say it clearly and unmistakably: the way you are being paid now for your services is being phased out. 

The change will not be abrupt or sweeping but slowly you will stop billing payers directly. Instead, you will be reimbursed by the Medical Home groups (teams) with which you work. Why? Because the groups who are paid to coordinate all care for their patients will also receive bundled payments for those services and will be required to distribute funds to the participating providers based on their contribution to the care of the patient.

Surprised? Shocked perhaps? This payment model raises concerns and questions, to be sure. However, a greater question than any about being inside that reimbursement model is the question about being outside it. It is this very issue that brought us to state years ago already that "health care reform is not about stimulus money; it is about the survival of your business." What happens to your business when access to your patients is controlled by a patient-centered medical home and you don't qualify to participate therein?

At phase 5, it's important to trace all the way back to phase 1. Despite its possible flaws, questions and concerns, if you want to be on the inside of the new payment model, you must have passed successfully through phases 1 to 4. You need EHRs so you may communicate (electronically exchange protected health information with other providers) ... so you may participate in team-based care delivery ... and be accepted onto coordinated care teams ... and be one of the providers who participates in the distribution of bundled payments and shared savings.

Without question, these are alarming statements. Be assured though, no crystal ball was required to see it coming. The evidence and pilot projects that reveal the inner workings of the new delivery system are all around us.  We need only know what to look for and how to engage. Again, that's the raison d'être of the National Eye Care Communications Project. We're still in the early days of bundled payment models. There's time ... but no time to waste.

Alistair Jackson, M.Ed.

Jim Grue, O.D.

Beyond EHRs - Phase 4

Today's post focuses on the fourth of a 5-phase continuum. If you're joining the discussion today for the first time, please refer back to our July 20th post for the big-picture overview.

Assuming you're working through the phases of the "beyond EHRs" continuum, you've implemented a certified and Direct-enabled EHR, you have tested Direct communications with other Direct-enabled colleagues and perhaps exchanged CCDs with one of your local Primary Care Physicians who is also Direct-enabled. In so doing, you have been preparing for and participating in the team delivery of care for some of your patients. 


Phase 4, Get accepted and involved in coordinated care moves us from the technology of team-based care to the practice thereof. As we saw in phase 1, certified EHR technology is really just a precursor to something bigger. So we need the technology of communications first. That's the Direct standard. It's a national standard and, very importantly for independent providers, it gives direct access both to other providers and to state Health Information Exchanges. All state-based HIEs are required to offer the Direct standard.


Now the relational piece. Getting accepted into a local ACO or a local PCP's coordinated care team is all about your value-added professional relationship. It's an application process. You must be qualified, professionally and technologically. You'll need to add value. Your competent use of the right EHRs, for example with advanced Clinical Decision Support, will aid greatly. And you'll need to be liked and valued as a colleague. After all, you'll work on a team for years to come with all the other team doctors.


One of the examples we've used in the case of the CPC Initiative (see earlier posts) is of helping your referral PCP understand the benefits of the Direct standard. Many are oblivious to it because they're affiliated with large health system that primarily use a closed HIE. If you can help the PCP communicate - send and receive CCDs for your shared patients - you truly add value. That value is what will make the PCP want you as part of her or his care team.

Last point for today: navigating the tides of change in healthcare is not easy. Nothing in itself is particularly hard; it's knowing what to do, what not to do, where to turn. The NECC Project is designed for you to navigate these waters in the company of your colleagues. We offer free and open webinars every 2nd and 4th Tuesday of the month. Join our LinkedIN group, National Eye Care Communications Project, to get the details.

Alistair Jackson, M.Ed.
Jim Grue, O.D.

Beyond EHRs - Phase 3

Today's post focuses on the third of a 5-phase continuum. If you're joining the discussion today for the first time, please refer back to our July 20th post for the big-picture overview.

Phase 3 of the "beyond EHRs" continuum is prepare for team delivery of care. Team delivery of care is being piloted all across the country. For some time now, we have been seeing and hearing of shared savings programs and accountable care organizations. Those programs and entities may have led us to believe team-based care is primarily for hospitals where we perceive that team care is the norm. 


Let's pause there for a moment and consider an important change management principle found throughout health care reform: change will be pilot tested in select environments then applied system wide. This means that in due course, sooner than you may think, team delivery will affect your business. Another truism readily observed: pilot programs will be financially incentivized to create momentum but in the end health care reform will drive "higher quality lower cost". Get involved in pilot projects!


A recent pilot project that is quickly and decisively changing anyone's view that team-based care delivery may only be for hospitals and health systems is the Comprehensive Primary Care Initiative, from CMS Innovations. Effectively, the CPC Initiative is moving patient-centered medical homes into the offices of Primary Care Physicians. Once again, this is a project we are following closely as part of our National Eye Care Communications Project. If you haven't already done so, read our post from June 13. It touches more thoroughly on this initiative.


Our big takeaway here is one word: prepare. As your colleague Dr. David Chandler said in his July 16 commentary, "...We've had our heads buried in the sand too long already." The profession is forcibly in a reactive mode. Without forethought and preparation, independent ECPs will lose out on many opportunities to be involved in team delivery of care. We've said it before, teams want eye care participation. That's not the problem. The question is whether the ECPs will be private practice or employed doctors. 


Prepare your business for team delivery of care!

Alistair Jackson, M.Ed.
Jim Grue, O.D.

Coordinated care leads to bundled payments

Coordinated care is by no means a new concept or recent buzzword but it does flag some important developments in the ongoing transformation of health care. In our discussions with eye care providers it is not yet apparent that many have grasped the significance of press releases like the one on June 6 from CMS entitled, “CMS Announces Private-Sector Commitments to Improve Primary Care for Patients, Save Money for Medicare: Eight States will test unique investment in coordinated care”. 

“In a strong show of support for more effective, more affordable, higher quality health care, 45 commercial, federal and State insurers in seven markets today pledged to work with the Centers for Medicare & Medicaid Services (CMS) to give more Americans access to quality health care at lower cost.”

The announcement goes on to explain a new initiative that impacts the business of every eye care provider from coast to coast, even though it specifies pilot projects in only eight states. Why is this important to you as an ECP? Because pilot projects like these signal ubiquitous change. If we understand the big picture, we can see that coordinated care spells the eventual demise of fee-for-service care billed directly by you to CMS or any other payer. To the extent that you don’t bill much to CMS, look past Medicare and Medicaid. See the private-sector commitments and public-private partnerships. Ubiquitous change.

“Under the Comprehensive Primary Care initiative, CMS will pay primary care practices a care management fee, initially set at an average of $20 per beneficiary per month, to support enhanced, coordinated services. Simultaneously, participating commercial, State, and other federal insurance plans are also offering an enhanced payment to primary care practices that provide high-quality primary care. 

"We know that when we support primary care, we get healthier patients and lower costs," said Acting CMS Administrator Marilyn Tavenner, "This initiative shows that the public and private sectors can come together to meet the critical need for these services."

Insurers in Arkansas, Colorado, New Jersey, Oregon, New York’s Capital District-Hudson Valley Region, Ohio’s and Kentucky’s Cincinnati-Dayton Region, and greater Tulsa, Oklahoma signed agreements with CMS to participate in this initiative. The markets were selected based on a diverse pool of applicants from commercial health plans, State Medicaid agencies, and self-insured businesses who hoped to work alongside Medicare to support comprehensive primary care. 

In order to receive the new care management fee from CMS and insurers, primary care practices must agree to provide enhanced services for their patients, including offering longer and more flexible hours, using electronic health records; delivering preventive care; coordinating care with patients’ other health care providers; engaging patients and caregivers in managing their own care, and providing individualized, enhanced care for patients living with multiple chronic diseases and higher needs. 

Approximately 75 primary care practices will be selected to participate in the Comprehensive Primary Care initiative in each designated market ...

The Comprehensive Primary Care initiative is a four-year initiative administered by the Innovation Center. Applications will be accepted until July 20.

For more information, please go to: http://www.innovations.cms.gov/initiatives/Comprehensive-Primary-Care-Initiative/index.html”

Takeaways for you as an independent eye care provider:

1. Getting connected with primary care is imperative to the survival of your business.
2. Coordinated care management fees mean that qualified entities will take over the complete care of the patient, including assigning their eye care provider.
3. Enhanced services include using EHRs, delivering preventive care (that’s you!) and coordinating care with patients’ other health care providers (that’s team-based care).
4. Chronic care is defined as two back-to-back billings by a provider for the same condition or diagnosis (that’s everyone, all your patients in due course).
5. Coordinating care with other health care providers means electronic communications … exchanging CCDs and other forms of patient information.
6. The National Eye Care Communications Project is focused precisely on helping you meet these requirements. 
7. The CMS Innovation website is a tremendous resource for understanding where the transformation of healthcare is taking us. We strongly recommend that you go there and read up on ACOs, Bundled Payments and the Comprehensive Primary Care Initiative. Links to all three topics are available in the bottom section of the home page.
8. Join us next day for more on the logical conclusion of coordinated care ... bundled payments.

Alistair Jackson, M.Ed.

Jim Grue, O.D.

Communications, Connected Care and Medical Homes, Part 1

What are Medical Homes? 
In the previous post, we saw that ACOs are rapidly becoming the new status quo in healthcare delivery and reimbursement. Healthcare is becoming team-based and reimbursement likewise. Patient-Centered Medical Homes (PCMHs) are taking flight within ACOs. 


From the American Academy of Family Physicians (AAFP), here are four building blocks your local PCPs are using to build the practice as a Medical Home.   Note the significance of the patient experience. 


Building Your PCMH?


A truly patient-centered medical home is designed to enhance the patient experience – a fundamental, transformational shift from the practice designed to enhance physician workflow.


In a medical home, the practice is organized around the patient. Communication is based on trust, respect and shared decision-making. Patients want access to personalized, coordinated and comprehensive primary care when they need it, when it’s convenient for them. They also want convenient access to practice information.
• Provide convenient care. 
• Develop your practice's online presence. 
• Assess patient satisfaction. 


A patient-centered medical home automates business and clinical processes, depends on clinical decision support tools, and connects patients with the health care team.
• Connect and communicate: e-Prescribing, email and secure electronic messaging.
• Clinical data: capture and analyze. Medication histories, for starters. 

Two fundamentals for a patient-centered medical home: an engaged and productive staff and an organized and disciplined approach to finances.
• Build a productive and supporting environment 
• Put finances in order 
• Install a system to collect data.  
• Use the system to improve care. 


To be continued. Join us next to see why Medical Homes are relevant to the National Eye Care Communications Project.


Alistair Jackson, M.Ed.
Jim Grue, O.D.