KENTUCKY REGIONAL EXTENSION CENTER

University of Louisville Physicians – Pediatrics, which recently combined with Norton Healthcare and the University of Louisville School of Medicine in order to strengthen and enhance medical care for children in the region, has made the Patient-Centered Medical Home recognition program a high priority for a number of years. We interviewed Dr. Melissa Hancock and Amanda Cagle about their journey to discuss why they decided this quality improvement recognition program with NCQA (the National Committee for Quality Assurance) is the right path to take for their organization.

From the NCQA Website: The patient-centered medical home is a model of care that puts patients at the forefront of care. PCMHs build better relationships between patients and their clinical care teams. Research shows that PCMHs improve quality and the patient experience, and increase staff satisfaction—while reducing health care costs. Practices that earn recognition have made a commitment to continuous quality improvement and a patient-centered approach to care.

With the help of Kentucky REC PCMH/PCSP senior advisor Vance Drakeford, a NCQA Certified Content Expert, they achieved NCQA certification for their three sites in 2018 and 2019, and recently renewed their certification on their own. Dr. Hancock found out about PCMH from a conference she attended in 2014, and immediately became enthused about the program and what it could mean for their providers, support staff, and patients. However, at that time program and the standards were very paper driven and they struggled with implementing and tracking everything. In 2017, the program changed to an electronic platform, which was a better fit for them. And, when Amanda joined the practice, they created a team to help move them through the process. They sought the help of Vance at the Kentucky REC, who was able to guide them through the process and maximize their efforts to achieve recognition. They were able to change many processes in their offices that had a direct impact on their patients.

What is the most rewarding part of your PCMH journey so far? Amanda mentioned multiple results:

Standardization – “We were able to standardize actions across our locations, and improved practice administration and patient care. We had immediate benefits with improvements in health outcomes.”
Employee Engagement – “Employee engagement and satisfaction is better, with improved communication. Our staff huddles and team communication are much more effective. We beefed up care coordination and chronic care management improved greatly. It really ramped up during this process, and continues to improve.”
Patient Care – “We were able to change many of the processes in each of the offices that had a direct impact on our patients, such as how we return phone calls, follow-ups on overdue labs and x-rays, how we schedule, and improvements in continuity. Our chronic care management improved greatly. And we have fewer patients heading to the ED.”

What was the hardest part of the process? Dr Hancock shared the issues they faced:
Quality Improvement – “We really struggled with the QI piece. Vance helped us so much. He made sense of it and pushed us through to complete the process. IT was the best for us in the long run, as we raised immunization rates, did better screenings for lead levels, and more.”
IT – “This was a huge barrier to get over,” Amanda said. “We recommend getting IT people involved early and setting expectations for reporting needs and frequency.”
Team – “We didn’t do well until we had an engaged team. Once Amanda joined us, and we had Vance to advise us, we were able to get together and complete the project.”

Was there anything easy?
Dr. Hancock answered, “The standards, figuring out the things we were already doing, but weren’t documenting. We realized we just needed to write them down as a policy or procedure, and refine them in order to get credit for them. ”

How did Kentucky REC help?
“We found out about Kentucky REC through an email, and then we participated in a webinar,” Dr. Hancock answered. “We had really hit a wall. We had done everything we could.Vance is so organized, with check ins and calls. He walked us through the difficult parts. It’s great having that different set of eyes. He knows what NCQA is looking for, where we didn’t know what we were doing. We had no frame of reference to discern what we needed to do to gain recognition. Once we started with the REC, we would send things to Vance, and he would send feedback with recommendations, and give us encouragement. We wouldn’t have gotten to the finish line without him. He’s personable, trustworthy, and super professional, super organized so we could get it done.”

How does this help your long term goals? Has anything worked for you with interventions?
“We have more QI efforts we’re working on right now, to improve for next year. We’re working on HIV screening rates in adolescents, HPV vaccine, BMI and healthy weight for children. We can now track and improve on interventions, like in HIV screening, we have reminders up in charting areas, and videos for providers to watch with reminders. The downtown office had a 5-10% bump. We now have a process to document why parents or kids refuse, along with the multiple charting reminders. The Stone Street office hasn’t seen an increase. Before, this would have fallen through the cracks, because we wouldn’t know how to do Quality Improvement tracking.

Do you have any advice for other organizations?
Amanda said, “Get IT people involved early and set expectations on reporting needs and frequency. It was a huge barrier to get over at first, and then it got better.” Dr. Hancock replied, “Vance helped us immensely. We had done everything that we could do on our own. We had no money, but we scraped it together to have the Kentucky REC advise us and get through the process. We needed the Quality Improvement piece, IT and technology abilities. Vance really pushed us through to get the project completed. We really recommend having advisors from your organization.”

Does your practice have Quality Improvement goals that PCMH/PCSP recognition might fit? Contact us at Kentucky REC to discuss how this program can help you achieve them. Our team of experts is here to help: 859-323-3090.