Re: Ideal Home certification

[Guest guest]

Is there any likelihood of an Ideal Medical Home alternative to PCMH

certification this year?

Our business manager reports we're now getting pressured by some

third party payers to get PCMH certification or suffer higher

copays, etc.  I'd prefer to have us get Ideal Medical Home

certifcation if that's available this year.

 

 

So here is a  fundamental problem-   without a network 

that is strong regionally  what   good will IMP

certification be?

Employers will want a network  of  docs locally to send

employees/patietns to. Sometimes employes and insurers

have agrreement to provide "wide access" --lots of docs in

a given area.

It is true I think  t hat hospital employed  PCPs are 

going to be one more faction  like specialists in some all

out  war for reimbursement ,as alluded to earlier  As

my day showed me- whenever I refer people to the local 

health access assistance program they LOVE me- and get a

card saying they are eligible to see  me for 5.00 a visit(

there is a sliding fee but no one who needs to be referred

there ever seems to  qualify EVER for the 50% 60% 90%

part) so the patients are offered varius things by me to

work out payment.  NOPE They want to  be seen for  5.00

and transfer away They loveme that I told them essentially

to take their business elsewhere and they go to the

hospital practices  where providers are provider based 

genereating huge fees that my taxes pay for to subsidize

this nonsense.The same taxes I am behind on a nd cannot

pay  Becasue I cannot see enough pateints

Who can stop this? Thisis evil cut us  all down/ make

enemies of each other stuff ? How to stop this? Should I

mediatte???Because I am becoming hateful. Can i ethcially

not tell people about this program that would help them

but shoots me i n the foot? How  do I find a path to msile

and  be quiet when someone brings up the direct pay "if

they values you they would pay speech?"

 but  to get a networkl of certified  docs  who do we team

up with... who?  to form  up a network? IMPs are many now,

but  few compared to the whole, and  very  scattered. And

I am wrestling with this crappy anger al lt he time.

Jean

On Mon, Feb 15, 2010 at 6:06 PM,

Pierce <bpiercemidcoastmedicine>

wrote:

 

I agree.  This could be very helpful.

This would be great publicity for our

individual clinics and the IMP

association if we could certify before the big

clinics start announcing

their NCQA certifications.  We could claim

some of the medical home

hype for IMP.  If we each do this after the

big clinics, it won't get

nearly as much attention.

 

that is exciting news about an IMP

certification process !  i am

definitely interested in that.  

i'll be finishing residency june 2011

and hope to open my own

practice right off the bat.  it would be

great to get certified and

gain credibility.

thuc huynh

http://good.md

--

PATIENTS,please remember email may not be entirely secure

and that Email is part of the medical  record and is placed

into the chart ( be careful what you say!)

Email is best used for appointment making and  brief

 questions

Email replies can be expected within 24 hours-Please CALL

 if the  matter is more urgent .

    MD

   

   

ph   fax

impcenter.org

[Guest guest]

Yes, we have a beta team working on this right now, but our self-assessment recognition program may not solve your problems with your third party payers. We will have a process by which you can verify the degree to which your practice matches the criteria of high performing primary care, but the current rubric chosen by most plans is driven by the NCQA and appears to have a different goal in mind.Gordon

Is there any likelihood of an Ideal Medical Home alternative to PCMH

certification this year?

Our business manager reports we're now getting pressured by some

third party payers to get PCMH certification or suffer higher

copays, etc. I'd prefer to have us get Ideal Medical Home

certifcation if that's available this year.

So here is a fundamental problem- without a network

that is strong regionally what good will IMP

certification be?

Employers will want a network of docs locally to send

employees/patietns to. Sometimes employes and insurers

have agrreement to provide "wide access" --lots of docs in

a given area.

It is true I think t hat hospital employed PCPs are

going to be one more faction like specialists in some all

out war for reimbursement ,as alluded to earlier As

my day showed me- whenever I refer people to the local

health access assistance program they LOVE me- and get a

card saying they are eligible to see me for 5.00 a visit(

there is a sliding fee but no one who needs to be referred

there ever seems to qualify EVER for the 50% 60% 90%

part) so the patients are offered varius things by me to

work out payment. NOPE They want to be seen for 5.00

and transfer away They loveme that I told them essentially

to take their business elsewhere and they go to the

hospital practices where providers are provider based

genereating huge fees that my taxes pay for to subsidize

this nonsense.The same taxes I am behind on a nd cannot

pay Becasue I cannot see enough pateints

Who can stop this? Thisis evil cut us all down/ make

enemies of each other stuff ? How to stop this? Should I

mediatte???Because I am becoming hateful. Can i ethcially

not tell people about this program that would help them

but shoots me i n the foot? How do I find a path to msile

and be quiet when someone brings up the direct pay "if

they values you they would pay speech?"

but to get a networkl of certified docs who do we team

up with... who? to form up a network? IMPs are many now,

but few compared to the whole, and very scattered. And

I am wrestling with this crappy anger al lt he time.

Jean

On Mon, Feb 15, 2010 at 6:06 PM,

Pierce <bpiercemidcoastmedicine>

wrote:

I agree. This could be very helpful.

This would be great publicity for our

individual clinics and the IMP

association if we could certify before the big

clinics start announcing

their NCQA certifications. We could claim

some of the medical home

hype for IMP. If we each do this after the

big clinics, it won't get

nearly as much attention.

that is exciting news about an IMP

certification process ! i am

definitely interested in that.

i'll be finishing residency june 2011

and hope to open my own

practice right off the bat. it would be

great to get certified and

gain credibility.

thuc huynh

http://good.md

--

PATIENTS,please remember email may not be entirely secure

and that Email is part of the medical record and is placed

into the chart ( be careful what you say!)

Email is best used for appointment making and brief

questions

Email replies can be expected within 24 hours-Please CALL

if the matter is more urgent .

MD

ph fax

impcenter.org

[Guest guest]

More on the same theme:I have been part of some very encouraging conversations with health plans that 1: recognize the inherent flaws in the NCQA process, 2: Want some meaningful way to assess "medical home-ness", and 3: are interested in the HowsYourHealth data.This bodes well for our future. Gordon

Yes, we have a beta team working on this right now, but our self-assessment recognition program may not solve your problems with your third party payers. We will have a process by which you can verify the degree to which your practice matches the criteria of high performing primary care, but the current rubric chosen by most plans is driven by the NCQA and appears to have a different goal in mind.Gordon

Is there any likelihood of an Ideal Medical Home alternative to PCMH

certification this year?

Our business manager reports we're now getting pressured by some

third party payers to get PCMH certification or suffer higher

copays, etc. I'd prefer to have us get Ideal Medical Home

certifcation if that's available this year.

So here is a fundamental problem- without a network

that is strong regionally what good will IMP

certification be?

Employers will want a network of docs locally to send

employees/patietns to. Sometimes employes and insurers

have agrreement to provide "wide access" --lots of docs in

a given area.

It is true I think t hat hospital employed PCPs are

going to be one more faction like specialists in some all

out war for reimbursement ,as alluded to earlier As

my day showed me- whenever I refer people to the local

health access assistance program they LOVE me- and get a

card saying they are eligible to see me for 5.00 a visit(

there is a sliding fee but no one who needs to be referred

there ever seems to qualify EVER for the 50% 60% 90%

part) so the patients are offered varius things by me to

work out payment. NOPE They want to be seen for 5.00

and transfer away They loveme that I told them essentially

to take their business elsewhere and they go to the

hospital practices where providers are provider based

genereating huge fees that my taxes pay for to subsidize

this nonsense.The same taxes I am behind on a nd cannot

pay Becasue I cannot see enough pateints

Who can stop this? Thisis evil cut us all down/ make

enemies of each other stuff ? How to stop this? Should I

mediatte???Because I am becoming hateful. Can i ethcially

not tell people about this program that would help them

but shoots me i n the foot? How do I find a path to msile

and be quiet when someone brings up the direct pay "if

they values you they would pay speech?"

but to get a networkl of certified docs who do we team

up with... who? to form up a network? IMPs are many now,

but few compared to the whole, and very scattered. And

I am wrestling with this crappy anger al lt he time.

Jean

On Mon, Feb 15, 2010 at 6:06 PM,

Pierce <bpiercemidcoastmedicine>

wrote:

I agree. This could be very helpful.

This would be great publicity for our

individual clinics and the IMP

association if we could certify before the big

clinics start announcing

their NCQA certifications. We could claim

some of the medical home

hype for IMP. If we each do this after the

big clinics, it won't get

nearly as much attention.

that is exciting news about an IMP

certification process ! i am

definitely interested in that.

i'll be finishing residency june 2011

and hope to open my own

practice right off the bat. it would be

great to get certified and

gain credibility.

thuc huynh

http://good.md

--

PATIENTS,please remember email may not be entirely secure

and that Email is part of the medical record and is placed

into the chart ( be careful what you say!)

Email is best used for appointment making and brief

questions

Email replies can be expected within 24 hours-Please CALL

if the matter is more urgent .

MD

ph fax

impcenter.org

[Guest guest]

 

More on the same theme:

I have been part of some very encouraging conversations

with health plans that 1: recognize the inherent flaws in

the NCQA process, 2: Want some meaningful way to assess

"medical home-ness", and 3: are interested in the

HowsYourHealth data.

This bodes well for our future. 

Gordon

__,_._,

That's encouraging.   Our new need to meet the NCQA criteria to

avoid penalties is taking time and energy that would've gone toward

incorporating HYH or other ideal methods.

__

[Guest guest]

I ran into this question recently.  One insurance plan is marketing its services as linked to medical homes.  For a subset of patients in the plan it is mandatory that they go to a medical home. I contacted provider relations stating my practice already has the features of a medical home.  Provider rep states they do not offer medical home designation to solo practices at this time.  As an IMP modeled practice with the cardinal features that Gordon described, I believe I can offer a medical home to my patients.

 

It would be a big difference for patients to be part of an IMP medical home versus an industrial medical feedlot where patients are herded like cows and you get care from a harried physican who does not really know you.

 

 

 

More on the same theme:

I have been part of some very encouraging conversations with health plans that 1: recognize the inherent flaws in the NCQA process, 2: Want some meaningful way to assess " medical home-ness " , and 3: are interested in the HowsYourHealth data.

This bodes well for our future. 

Gordon

__,_._,That's encouraging.   Our new need to meet the NCQA criteria to avoid penalties is taking time and energy that would've gone toward incorporating HYH or other ideal methods.

__

[Guest guest]

Yes, I wince as I think of all the time and effort practices across the US are pouring into the current process. We all need to push back on interventions that have no basis in evidence. We are appropriately being asked to use evidence in our work, we are expected to avoid unnecessary use of resources. The NCQA PPC-PCMH yardstick fails to clear these hurdles and if we are to maintain our professional integrity we should reject it. The tool might be useful as part of a metric validation study.Here's a quotation from one of the real heavy hitter researchers in the field:"Holmboe et al. (2010) argued that it is inadequate to rely solely on measures of the presence of practice systems and report on a study of 202 general internists in small practices in 13 states. They found little association between practice scores on the NCQA recognition tool and chart-audit measures of care quality, concluding that such system measures are not a proxy for quality." Leif Solberg MD, How Can We Remodel Practices into Medical Homes Without a Blueprint or a Bank Account? Journal of Ambulatory Care Management Vol. 34, No. 1, pp 3-9.The quote refers to:Holmboe et al. Current yardsticks may be inadequate for measuring quality improvements from the medical home. Health Affairs 29(5), 859-866.Gordon

More on the same theme:

I have been part of some very encouraging conversations

with health plans that 1: recognize the inherent flaws in

the NCQA process, 2: Want some meaningful way to assess

"medical home-ness", and 3: are interested in the

HowsYourHealth data.

This bodes well for our future.

Gordon

__,_._,

That's encouraging. Our new need to meet the NCQA criteria to

avoid penalties is taking time and energy that would've gone toward

incorporating HYH or other ideal methods.

__

[Guest guest]

Yes, I wince as I think of all the time and effort practices across the US are pouring into the current process. We all need to push back on interventions that have no basis in evidence. We are appropriately being asked to use evidence in our work, we are expected to avoid unnecessary use of resources. The NCQA PPC-PCMH yardstick fails to clear these hurdles and if we are to maintain our professional integrity we should reject it. The tool might be useful as part of a metric validation study.Here's a quotation from one of the real heavy hitter researchers in the field:"Holmboe et al. (2010) argued that it is inadequate to rely solely on measures of the presence of practice systems and report on a study of 202 general internists in small practices in 13 states. They found little association between practice scores on the NCQA recognition tool and chart-audit measures of care quality, concluding that such system measures are not a proxy for quality." Leif Solberg MD, How Can We Remodel Practices into Medical Homes Without a Blueprint or a Bank Account? Journal of Ambulatory Care Management Vol. 34, No. 1, pp 3-9.The quote refers to:Holmboe et al. Current yardsticks may be inadequate for measuring quality improvements from the medical home. Health Affairs 29(5), 859-866.Gordon

More on the same theme:

I have been part of some very encouraging conversations

with health plans that 1: recognize the inherent flaws in

the NCQA process, 2: Want some meaningful way to assess

"medical home-ness", and 3: are interested in the

HowsYourHealth data.

This bodes well for our future.

Gordon

__,_._,

That's encouraging. Our new need to meet the NCQA criteria to

avoid penalties is taking time and energy that would've gone toward

incorporating HYH or other ideal methods.

__

[Guest guest]

I am shocked that an insurance carrier would explicitly exclude solo practices from this work. Solo practices still make up a huge percentage of practices in the US and there is nothing inherent in solo that contradicts high performing primary care. In fact (as you've alluded below), there are indications that larger institutional health care may have more difficulty achieving meaningful medical home-ness because of internal bureaucratic complexity.Gordon

I ran into this question recently. One insurance plan is marketing its services as linked to medical homes. For a subset of patients in the plan it is mandatory that they go to a medical home. I contacted provider relations stating my practice already has the features of a medical home. Provider rep states they do not offer medical home designation to solo practices at this time. As an IMP modeled practice with the cardinal features that Gordon described, I believe I can offer a medical home to my patients.

It would be a big difference for patients to be part of an IMP medical home versus an industrial medical feedlot where patients are herded like cows and you get care from a harried physican who does not really know you.

More on the same theme:

I have been part of some very encouraging conversations with health plans that 1: recognize the inherent flaws in the NCQA process, 2: Want some meaningful way to assess "medical home-ness", and 3: are interested in the HowsYourHealth data.

This bodes well for our future.

Gordon

__,_._,That's encouraging. Our new need to meet the NCQA criteria to avoid penalties is taking time and energy that would've gone toward incorporating HYH or other ideal methods.

__

[Guest guest]

I am shocked that an insurance carrier would explicitly exclude solo practices from this work. Solo practices still make up a huge percentage of practices in the US and there is nothing inherent in solo that contradicts high performing primary care. In fact (as you've alluded below), there are indications that larger institutional health care may have more difficulty achieving meaningful medical home-ness because of internal bureaucratic complexity.Gordon

I ran into this question recently. One insurance plan is marketing its services as linked to medical homes. For a subset of patients in the plan it is mandatory that they go to a medical home. I contacted provider relations stating my practice already has the features of a medical home. Provider rep states they do not offer medical home designation to solo practices at this time. As an IMP modeled practice with the cardinal features that Gordon described, I believe I can offer a medical home to my patients.

It would be a big difference for patients to be part of an IMP medical home versus an industrial medical feedlot where patients are herded like cows and you get care from a harried physican who does not really know you.

More on the same theme:

I have been part of some very encouraging conversations with health plans that 1: recognize the inherent flaws in the NCQA process, 2: Want some meaningful way to assess "medical home-ness", and 3: are interested in the HowsYourHealth data.

This bodes well for our future.

Gordon

__,_._,That's encouraging. Our new need to meet the NCQA criteria to avoid penalties is taking time and energy that would've gone toward incorporating HYH or other ideal methods.

__

[Guest guest]

I am shocked that an insurance carrier would explicitly exclude solo practices from this work. Solo practices still make up a huge percentage of practices in the US and there is nothing inherent in solo that contradicts high performing primary care. In fact (as you've alluded below), there are indications that larger institutional health care may have more difficulty achieving meaningful medical home-ness because of internal bureaucratic complexity.Gordon

I ran into this question recently. One insurance plan is marketing its services as linked to medical homes. For a subset of patients in the plan it is mandatory that they go to a medical home. I contacted provider relations stating my practice already has the features of a medical home. Provider rep states they do not offer medical home designation to solo practices at this time. As an IMP modeled practice with the cardinal features that Gordon described, I believe I can offer a medical home to my patients.

It would be a big difference for patients to be part of an IMP medical home versus an industrial medical feedlot where patients are herded like cows and you get care from a harried physican who does not really know you.

More on the same theme:

I have been part of some very encouraging conversations with health plans that 1: recognize the inherent flaws in the NCQA process, 2: Want some meaningful way to assess "medical home-ness", and 3: are interested in the HowsYourHealth data.

This bodes well for our future.

Gordon

__,_._,That's encouraging. Our new need to meet the NCQA criteria to avoid penalties is taking time and energy that would've gone toward incorporating HYH or other ideal methods.

__

[Guest guest]

So here's the question we could pose:

Are you going to believe accountants and clerks, who count numbers and make spreadsheets, databases, and charts, about whether a provider is giving excellent care?

Or might you believe the patients who receive that care (thus, How's Your Health)?

Paternalism, in the form of decision makers in cubicles at this point (in governmental and private insurance offices), is a serious detriment to excellent care -- ask any patient who has been told, "Just take this pill," or "It's all in your head," or "You're just stressed out," or "I can see you in two weeks for your UTI," or "That's not a covered benefit."

When we count only numbers -- blood pressure, HgbA1C -- and we don't ask the recipient of care what the quality was like, we make these same paternalistic errors, and we assume our patients are stupid and wouldn't know good care if they received it.

I'm sure all of you are having the same experience I am -- my patients love the time and care I give them. They tell me all the time, "No one has ever been this thorough -- taken this much time -- helped me work on this problem so well." The good numbers always follow -- but they are a result, not a predictor, of this kind of care.

Deanna Tolman, FNP

Re: Ideal Home certification

I am shocked that an insurance carrier would explicitly exclude solo practices from this work. Solo practices still make up a huge percentage of practices in the US and there is nothing inherent in solo that contradicts high performing primary care. In fact (as you've alluded below), there are indications that larger institutional health care may have more difficulty achieving meaningful medical home-ness because of internal bureaucratic complexity.

Gordon

I ran into this question recently. One insurance plan is marketing its services as linked to medical homes. For a subset of patients in the plan it is mandatory that they go to a medical home. I contacted provider relations stating my practice already has the features of a medical home. Provider rep states they do not offer medical home designation to solo practices at this time. As an IMP modeled practice with the cardinal features that Gordon described, I believe I can offer a medical home to my patients.

It would be a big difference for patients to be part of an IMP medical home versus an industrial medical feedlot where patients are herded like cows and you get care from a harried physican who does not really know you.

More on the same theme:

I have been part of some very encouraging conversations with health plans that 1: recognize the inherent flaws in the NCQA process, 2: Want some meaningful way to assess "medical home-ness", and 3: are interested in the HowsYourHealth data.

This bodes well for our future.

Gordon

__,_._,

That's encouraging. Our new need to meet the NCQA criteria to avoid penalties is taking time and energy that would've gone toward incorporating HYH or other ideal methods.

__

[Guest guest]

So here's the question we could pose:

Are you going to believe accountants and clerks, who count numbers and make spreadsheets, databases, and charts, about whether a provider is giving excellent care?

Or might you believe the patients who receive that care (thus, How's Your Health)?

Paternalism, in the form of decision makers in cubicles at this point (in governmental and private insurance offices), is a serious detriment to excellent care -- ask any patient who has been told, "Just take this pill," or "It's all in your head," or "You're just stressed out," or "I can see you in two weeks for your UTI," or "That's not a covered benefit."

When we count only numbers -- blood pressure, HgbA1C -- and we don't ask the recipient of care what the quality was like, we make these same paternalistic errors, and we assume our patients are stupid and wouldn't know good care if they received it.

I'm sure all of you are having the same experience I am -- my patients love the time and care I give them. They tell me all the time, "No one has ever been this thorough -- taken this much time -- helped me work on this problem so well." The good numbers always follow -- but they are a result, not a predictor, of this kind of care.

Deanna Tolman, FNP

Re: Ideal Home certification

I am shocked that an insurance carrier would explicitly exclude solo practices from this work. Solo practices still make up a huge percentage of practices in the US and there is nothing inherent in solo that contradicts high performing primary care. In fact (as you've alluded below), there are indications that larger institutional health care may have more difficulty achieving meaningful medical home-ness because of internal bureaucratic complexity.

Gordon

I ran into this question recently. One insurance plan is marketing its services as linked to medical homes. For a subset of patients in the plan it is mandatory that they go to a medical home. I contacted provider relations stating my practice already has the features of a medical home. Provider rep states they do not offer medical home designation to solo practices at this time. As an IMP modeled practice with the cardinal features that Gordon described, I believe I can offer a medical home to my patients.

It would be a big difference for patients to be part of an IMP medical home versus an industrial medical feedlot where patients are herded like cows and you get care from a harried physican who does not really know you.

More on the same theme:

I have been part of some very encouraging conversations with health plans that 1: recognize the inherent flaws in the NCQA process, 2: Want some meaningful way to assess "medical home-ness", and 3: are interested in the HowsYourHealth data.

This bodes well for our future.

Gordon

__,_._,

That's encouraging. Our new need to meet the NCQA criteria to avoid penalties is taking time and energy that would've gone toward incorporating HYH or other ideal methods.

__

[Guest guest]

So here's the question we could pose:

Are you going to believe accountants and clerks, who count numbers and make spreadsheets, databases, and charts, about whether a provider is giving excellent care?

Or might you believe the patients who receive that care (thus, How's Your Health)?

Paternalism, in the form of decision makers in cubicles at this point (in governmental and private insurance offices), is a serious detriment to excellent care -- ask any patient who has been told, "Just take this pill," or "It's all in your head," or "You're just stressed out," or "I can see you in two weeks for your UTI," or "That's not a covered benefit."

When we count only numbers -- blood pressure, HgbA1C -- and we don't ask the recipient of care what the quality was like, we make these same paternalistic errors, and we assume our patients are stupid and wouldn't know good care if they received it.

I'm sure all of you are having the same experience I am -- my patients love the time and care I give them. They tell me all the time, "No one has ever been this thorough -- taken this much time -- helped me work on this problem so well." The good numbers always follow -- but they are a result, not a predictor, of this kind of care.

Deanna Tolman, FNP

Re: Ideal Home certification

I am shocked that an insurance carrier would explicitly exclude solo practices from this work. Solo practices still make up a huge percentage of practices in the US and there is nothing inherent in solo that contradicts high performing primary care. In fact (as you've alluded below), there are indications that larger institutional health care may have more difficulty achieving meaningful medical home-ness because of internal bureaucratic complexity.

Gordon

I ran into this question recently. One insurance plan is marketing its services as linked to medical homes. For a subset of patients in the plan it is mandatory that they go to a medical home. I contacted provider relations stating my practice already has the features of a medical home. Provider rep states they do not offer medical home designation to solo practices at this time. As an IMP modeled practice with the cardinal features that Gordon described, I believe I can offer a medical home to my patients.

It would be a big difference for patients to be part of an IMP medical home versus an industrial medical feedlot where patients are herded like cows and you get care from a harried physican who does not really know you.

More on the same theme:

I have been part of some very encouraging conversations with health plans that 1: recognize the inherent flaws in the NCQA process, 2: Want some meaningful way to assess "medical home-ness", and 3: are interested in the HowsYourHealth data.

This bodes well for our future.

Gordon

__,_._,

That's encouraging. Our new need to meet the NCQA criteria to avoid penalties is taking time and energy that would've gone toward incorporating HYH or other ideal methods.

__

[Guest guest]

I also was told by local carrier they weren't interested in working with me --- I was too small.

To: Sent: Thu, February 10, 2011 2:56:31 PMSubject: Re: Ideal Home certification

I am shocked that an insurance carrier would explicitly exclude solo practices from this work. Solo practices still make up a huge percentage of practices in the US and there is nothing inherent in solo that contradicts high performing primary care. In fact (as you've alluded below), there are indications that larger institutional health care may have more difficulty achieving meaningful medical home-ness because of internal bureaucratic complexity. Gordon

I ran into this question recently. One insurance plan is marketing its services as linked to medical homes. For a subset of patients in the plan it is mandatory that they go to a medical home. I contacted provider relations stating my practice already has the features of a medical home. Provider rep states they do not offer medical home designation to solo practices at this time. As an IMP modeled practice with the cardinal features that Gordon described, I believe I can offer a medical home to my patients.

It would be a big difference for patients to be part of an IMP medical home versus an industrial medical feedlot where patients are herded like cows and you get care from a harried physican who does not really know you.

More on the same theme:

I have been part of some very encouraging conversations with health plans that 1: recognize the inherent flaws in the NCQA process, 2: Want some meaningful way to assess "medical home-ness", and 3: are interested in the HowsYourHealth data.

This bodes well for our future.

Gordon

__,_._,That's encouraging. Our new need to meet the NCQA criteria to avoid penalties is taking time and energy that would've gone toward incorporating HYH or other ideal methods.

__

[Guest guest]

I also was told by local carrier they weren't interested in working with me --- I was too small.

To: Sent: Thu, February 10, 2011 2:56:31 PMSubject: Re: Ideal Home certification

I am shocked that an insurance carrier would explicitly exclude solo practices from this work. Solo practices still make up a huge percentage of practices in the US and there is nothing inherent in solo that contradicts high performing primary care. In fact (as you've alluded below), there are indications that larger institutional health care may have more difficulty achieving meaningful medical home-ness because of internal bureaucratic complexity. Gordon

I ran into this question recently. One insurance plan is marketing its services as linked to medical homes. For a subset of patients in the plan it is mandatory that they go to a medical home. I contacted provider relations stating my practice already has the features of a medical home. Provider rep states they do not offer medical home designation to solo practices at this time. As an IMP modeled practice with the cardinal features that Gordon described, I believe I can offer a medical home to my patients.

It would be a big difference for patients to be part of an IMP medical home versus an industrial medical feedlot where patients are herded like cows and you get care from a harried physican who does not really know you.

More on the same theme:

I have been part of some very encouraging conversations with health plans that 1: recognize the inherent flaws in the NCQA process, 2: Want some meaningful way to assess "medical home-ness", and 3: are interested in the HowsYourHealth data.

This bodes well for our future.

Gordon

__,_._,That's encouraging. Our new need to meet the NCQA criteria to avoid penalties is taking time and energy that would've gone toward incorporating HYH or other ideal methods.

__

[Guest guest]

I also was told by local carrier they weren't interested in working with me --- I was too small.

To: Sent: Thu, February 10, 2011 2:56:31 PMSubject: Re: Ideal Home certification

I am shocked that an insurance carrier would explicitly exclude solo practices from this work. Solo practices still make up a huge percentage of practices in the US and there is nothing inherent in solo that contradicts high performing primary care. In fact (as you've alluded below), there are indications that larger institutional health care may have more difficulty achieving meaningful medical home-ness because of internal bureaucratic complexity. Gordon

I ran into this question recently. One insurance plan is marketing its services as linked to medical homes. For a subset of patients in the plan it is mandatory that they go to a medical home. I contacted provider relations stating my practice already has the features of a medical home. Provider rep states they do not offer medical home designation to solo practices at this time. As an IMP modeled practice with the cardinal features that Gordon described, I believe I can offer a medical home to my patients.

It would be a big difference for patients to be part of an IMP medical home versus an industrial medical feedlot where patients are herded like cows and you get care from a harried physican who does not really know you.

More on the same theme:

I have been part of some very encouraging conversations with health plans that 1: recognize the inherent flaws in the NCQA process, 2: Want some meaningful way to assess "medical home-ness", and 3: are interested in the HowsYourHealth data.

This bodes well for our future.

Gordon

__,_._,That's encouraging. Our new need to meet the NCQA criteria to avoid penalties is taking time and energy that would've gone toward incorporating HYH or other ideal methods.

__

[Guest guest]

Well said!

Jack

>

>

> More on the same theme:

> I have been part of some very encouraging conversations with health plans that

1: recognize the inherent flaws in the NCQA process, 2: Want some meaningful way

to assess " medical home-ness " , and 3: are interested in the HowsYourHealth data.

> This bodes well for our future.

> Gordon

>

>

> __,_._,

> That's encouraging. Our new need to meet the NCQA criteria to avoid

penalties is taking time and energy that would've gone toward incorporating HYH

or other ideal methods.

>

> __

>

[Guest guest]

Well said!

Jack

>

>

> More on the same theme:

> I have been part of some very encouraging conversations with health plans that

1: recognize the inherent flaws in the NCQA process, 2: Want some meaningful way

to assess " medical home-ness " , and 3: are interested in the HowsYourHealth data.

> This bodes well for our future.

> Gordon

>

>

> __,_._,

> That's encouraging. Our new need to meet the NCQA criteria to avoid

penalties is taking time and energy that would've gone toward incorporating HYH

or other ideal methods.

>

> __

>

[Guest guest]

NCQA does certify solo practitioners. You might tell your companies that.

>

> I am shocked that an insurance carrier would explicitly exclude solo

> practices from this work. Solo practices still make up a huge

> percentage of practices in the US and there is nothing inherent in

> solo that contradicts high performing primary care. In fact (as you've

> alluded below), there are indications that larger institutional health

> care may have more difficulty achieving meaningful medical home-ness

> because of internal bureaucratic complexity.

>

> Gordon

>

>

>>

>> I ran into this question recently. One insurance plan is marketing

>> its services as linked to medical homes. For a subset of patients in

>> the plan it is mandatory that they go to a medical home. I contacted

>> provider relations stating my practice already has the features of a

>> medical home. Provider rep states they do not offer medical home

>> designation to solo practices at this time. As an IMP modeled

>> practice with the cardinal features that Gordon described, I believe

>> I can offer a medical home to my patients.

>> It would be a big difference for patients to be part of an IMP

>> medical home versus an industrial medical feedlot where patients are

>> herded like cows and you get care from a harried physican who does

>> not really know you.

>> On Thu, Feb 10, 2011 at 10:53 AM, Pierce

>> >

>> wrote:

>>

>>

>>

>>>

>>> More on the same theme:

>>>

>>> I have been part of some very encouraging conversations with

>>> health plans that 1: recognize the inherent flaws in the NCQA

>>> process, 2: Want some meaningful way to assess " medical

>>> home-ness " , and 3: are interested in the HowsYourHealth data.

>>> This bodes well for our future.

>>> Gordon

>>>

>>> __,_._,

>> That's encouraging. Our new need to meet the NCQA criteria to

>> avoid penalties is taking time and energy that would've gone

>> toward incorporating HYH or other ideal methods.

>>> __

>>

>>

>>

>>

>>

>

>

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[Guest guest]

NCQA does certify solo practitioners. You might tell your companies that.

>

> I am shocked that an insurance carrier would explicitly exclude solo

> practices from this work. Solo practices still make up a huge

> percentage of practices in the US and there is nothing inherent in

> solo that contradicts high performing primary care. In fact (as you've

> alluded below), there are indications that larger institutional health

> care may have more difficulty achieving meaningful medical home-ness

> because of internal bureaucratic complexity.

>

> Gordon

>

>

>>

>> I ran into this question recently. One insurance plan is marketing

>> its services as linked to medical homes. For a subset of patients in

>> the plan it is mandatory that they go to a medical home. I contacted

>> provider relations stating my practice already has the features of a

>> medical home. Provider rep states they do not offer medical home

>> designation to solo practices at this time. As an IMP modeled

>> practice with the cardinal features that Gordon described, I believe

>> I can offer a medical home to my patients.

>> It would be a big difference for patients to be part of an IMP

>> medical home versus an industrial medical feedlot where patients are

>> herded like cows and you get care from a harried physican who does

>> not really know you.

>> On Thu, Feb 10, 2011 at 10:53 AM, Pierce

>> >

>> wrote:

>>

>>

>>

>>>

>>> More on the same theme:

>>>

>>> I have been part of some very encouraging conversations with

>>> health plans that 1: recognize the inherent flaws in the NCQA

>>> process, 2: Want some meaningful way to assess " medical

>>> home-ness " , and 3: are interested in the HowsYourHealth data.

>>> This bodes well for our future.

>>> Gordon

>>>

>>> __,_._,

>> That's encouraging. Our new need to meet the NCQA criteria to

>> avoid penalties is taking time and energy that would've gone

>> toward incorporating HYH or other ideal methods.

>>> __

>>

>>

>>

>>

>>

>

>

Attachment: vcard [not shown]

[Guest guest]

NCQA does certify solo practitioners. You might tell your companies that.

>

> I am shocked that an insurance carrier would explicitly exclude solo

> practices from this work. Solo practices still make up a huge

> percentage of practices in the US and there is nothing inherent in

> solo that contradicts high performing primary care. In fact (as you've

> alluded below), there are indications that larger institutional health

> care may have more difficulty achieving meaningful medical home-ness

> because of internal bureaucratic complexity.

>

> Gordon

>

>

>>

>> I ran into this question recently. One insurance plan is marketing

>> its services as linked to medical homes. For a subset of patients in

>> the plan it is mandatory that they go to a medical home. I contacted

>> provider relations stating my practice already has the features of a

>> medical home. Provider rep states they do not offer medical home

>> designation to solo practices at this time. As an IMP modeled

>> practice with the cardinal features that Gordon described, I believe

>> I can offer a medical home to my patients.

>> It would be a big difference for patients to be part of an IMP

>> medical home versus an industrial medical feedlot where patients are

>> herded like cows and you get care from a harried physican who does

>> not really know you.

>> On Thu, Feb 10, 2011 at 10:53 AM, Pierce

>> >

>> wrote:

>>

>>

>>

>>>

>>> More on the same theme:

>>>

>>> I have been part of some very encouraging conversations with

>>> health plans that 1: recognize the inherent flaws in the NCQA

>>> process, 2: Want some meaningful way to assess " medical

>>> home-ness " , and 3: are interested in the HowsYourHealth data.

>>> This bodes well for our future.

>>> Gordon

>>>

>>> __,_._,

>> That's encouraging. Our new need to meet the NCQA criteria to

>> avoid penalties is taking time and energy that would've gone

>> toward incorporating HYH or other ideal methods.

>>> __

>>

>>

>>

>>

>>

>

>

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[Guest guest]

I think it's time we had a Medical Home recognition process that's oriented to

smaller, more personal & attentive high quality practices.

I'm a bit confused-Ellen, do you already have NCQA Medical Home recognition? If

so, another direction to consider is your state or national specialty society-

get them to get their legal guns out for you. If you're not NCQA certified,

then we need to get some sort of " Really Primary Care Oriented " Medical Home

recognition process going!!

[Guest guest]

I think it's time we had a Medical Home recognition process that's oriented to

smaller, more personal & attentive high quality practices.

I'm a bit confused-Ellen, do you already have NCQA Medical Home recognition? If

so, another direction to consider is your state or national specialty society-

get them to get their legal guns out for you. If you're not NCQA certified,

then we need to get some sort of " Really Primary Care Oriented " Medical Home

recognition process going!!

[Guest guest]

I think it's time we had a Medical Home recognition process that's oriented to

smaller, more personal & attentive high quality practices.

I'm a bit confused-Ellen, do you already have NCQA Medical Home recognition? If

so, another direction to consider is your state or national specialty society-

get them to get their legal guns out for you. If you're not NCQA certified,

then we need to get some sort of " Really Primary Care Oriented " Medical Home

recognition process going!!

[Guest guest]

We're waiting to see if we've been recognized. 4 other small practices

in OR were just recognized. Portland IPA helped us all out with the process.

We are the only clinic without an EHR and they are not being as friendly

to us though their Survey Tool specifically says you don't have to have

an EHR.

Hopefully we'll know if a few wks. Small practices are different and

they are bugging us about the way we combined some of our cue systems to

make it

easier. They do not specify how anyone must do it, so it's really up to

the reviewer to pass/fail our work. The IPA person who helped us said

that each clinic

really had to figure out how to do it on their own--the two EHRs they

were using did not have cue/tickler systems set up. I hope we make it,

for the record.

But i'm all for a true Primary Care Oriented MH for smaller practices.

The NCQA model wants to depend on a " team " approach so it is already biased

against many IMPs. And we are not robots.

>

> I think it's time we had a Medical Home recognition process that's

> oriented to smaller, more personal & attentive high quality practices.

>

> I'm a bit confused-Ellen, do you already have NCQA Medical Home

> recognition? If so, another direction to consider is your state or

> national specialty society- get them to get their legal guns out for

> you. If you're not NCQA certified, then we need to get some sort of

> " Really Primary Care Oriented " Medical Home recognition process going!!

>

>

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