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  • Colorado Community Health Network | Safety Net Medical Home Initiative
    patients Providing resources to ensure that CHCs are strong organizations Supporting CHCs in maintaining the highest quality of care Goals for the Initiative The vision of this Regional Coordinating Center RCC was to use the resources and tools of this Initiative to build upon existing organizational priorities and state legislative support for a statewide patient centered medical home PCMH collaborative The role of the executive sponsor CCHN was to bridge health policy with the system change needed to advance the spread of the Patient Centered Medical Home Model to safety net providers Coordinate medical home initiatives across other Commonwealth funded PCMH initiatives in Colorado Develop a model toolkit and process of how every safety net clinic in Colorado can become a PCMH Define PCMH for Colorado safety net clinics in a way that is sensitive to the safety net system and the Colorado environment Provide recognition for Colorado safety net clinics for the high quality work they are doing and define and recognize opportunities for growth Throughout the four years of the PCMH initiative the expertise and resources of the national Project Team supported the implementation and effectiveness of the statewide collaborative The executive sponsor and key stakeholders coordinated activities around health policy healthcare delivery mechanisms and recommended practice improvement models to enhance the political financial and cultural environment that supports patient centered medical homes Partner Clinics Participating clinics included 10 federally qualified health centers FQHCs one non federally funded health center and two rural health centers While the majority of the selected sites are in the Denver Metro Area where most of the Colorado population resides selected clinics are on Colorado s eastern plains in mountain communities and in the San Luis Valley in southern Colorado The involvement of these diverse sites and communities allowed for greater spread of

    Original URL path: http://www.safetynetmedicalhome.org/about-initiative/rcc/colorado (2016-04-30)
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  • Idaho Primary Care Association | Safety Net Medical Home Initiative
    Boise Idaho s capital city provides fast access to Idaho s legislative body the Governor s office and the Department of Health and Welfare for issues affecting community health centers and their patients Goals for the Initiative The vision of the Regional Coordinating Center RCC was to build a statewide learning community with a goal of transforming safety net clinics into patient centered medical homes PCMHs The role of the RCC was to support safety net clinics in their transformation to PCMH over four years to assure that state health policy supports this transformation and to work with payers on reimbursement reforms that support the added value of the PCMH The RCC also worked to assure that this model of care is sustainable and able to spread to other healthcare settings in Idaho and beyond To this end the Idaho Primary Care Association worked to initiate the Idaho Medical Home Collaborative The Idaho Medical Home Collaborative IMHC was established through Executive Order by the Governor of Idaho to make recommendations on the development promotion and implementation of a Patient Centered Medical Home Model of Care statewide At the patient and clinic level our goals were to Improve health outcomes for chronic disease Improve patient clinician and staff satisfaction Improve clinic flow efficiency Provide a more comprehensive and coordinated approach to patient care Enhance provider recruitment and retention Prepare for healthcare reform Do the right thing for patients Assist all of our partner clinics in transforming their practices into patient centered medical homes Partner Clinics SNMHI Family Medicine Residency of Idaho Boise Idaho State University Family Medicine Residency Pocatello Terry Reilly Health Services Clinic Boise Terry Reilly Health Services Clinic Homedale Terry Reilly Health Services Clinic Melba Terry Reilly Health Services Clinic Nampa Terry Reilly Health Services Clinic Caldwell Terry Reilly

    Original URL path: http://www.safetynetmedicalhome.org/about-initiative/rcc/idaho (2016-04-30)
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  • Massachusetts Executive Office of Health and Human Services & Massachusetts League of Community Health Centers | Safety Net Medical Home Initiative
    Centers is a nonprofit statewide association representing and serving the needs of the state s 52 community health centers The League serves as an information source on community based healthcare to policymakers opinion leaders and the media and provides a wide range of technical assistance to its members and communities including Analysis of state and federal health regulatory and policy issues affecting health centers Training and Education for health center administrators clinicians and board members Workforce Development initiatives to increase recruitment of primary care physicians and to provide career training for both current health center employees and local residents seeking entry level positions at health centers Information Technology Development primarily focused on electronic medical records implementation Support to Expand Health Access through work with local health and advocacy organizations seeking to open health centers in their communities Goals for the Initiative Statewide Mission Design and implement a system to support high performing patient centered primary care delivery across the Commonwealth of Massachusetts Statewide Goal Transform all primary care practices in Massachusetts into high performing advanced medical homes Initiative Goal Transform Partner Sites into high performing advanced medical homes Medical Home Objectives Improve coordination of healthcare services across the continuum of care Enhance patient experience and health outcomes Increase provider satisfaction Provide incentives for improved quality and efficiency of care delivery Reduce unnecessary hospitalizations and emergency room visits and increase use of cost effective care and settings Foster expansion of technology infrastructure that supports collaboration Test innovative primary care systems to inform future directions Success at Partner Clinics Patient Centered Culturally Competent Care Engaged Practice Leadership Continuous Quality Improvement Strategy Organized Evidence Based Care Continuous and Team Based Relationships Appropriate Need Based and Broadened Access Data Driven Practice Management of Patient Panel Care Coordination and Communication Commitment to Cost Effective Care

    Original URL path: http://www.safetynetmedicalhome.org/about-initiative/rcc/massachusetts (2016-04-30)
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  • Oregon Primary Care Association & CareOregon | Safety Net Medical Home Initiative
    focus not just on health care but on total health Teaming with our members their families and communities we help them live better lives prevent illness and respond quickly and effectively to health issues CareOregon provides services to five Coordinated Care Organizations supporting and enhancing sensible localized coordinated care for physical and mental health We also support universal health care coverage by assisting in the formation of a CO OP to serve people on Oregon s health insurance exchange and offering Medicare plans and a small dental plan In addition we provide learning opportunities to health professionals designed to improve health delivery nationwide Oregon Rural Practice Based Research Network Oregon Rural Practice based Research Network ORPRN was a partner organization in the Initiative and participated as one of the Medical Home Facilitator Team members ORPRN coordinates clinical transformation activities between the Medical Home Facilitator Team and two partner clinics Eastern Oregon Medical Associates and Winding Waters ORPRN founded in 2002 is an active clinical research network spanning rural communities throughout the state of Oregon The network includes 171 clinician members in 50 primary care practices who care for over 240 000 patients One out of every five rural Oregon residents receives their care in an ORPRN affiliated practice ORPRN is nationally recognized as experts in Implementation Science The network conducts studies using at the elbow practice facilitation with their five Practice Enhancement Research Coordinators PERCs who have offices in rural Oregon ORPRN provides practice facilitation for 31 primary care practices undergoing transformation to a medical home through four projects funded by CMS AHRQ and private foundations Mission The mission of ORPRN is to improve the health of rural populations in Oregon through conducting and promoting health research in partnership with the communities and practitioners we serve Goals for the Initiative The vision for the RCC was to use the resources and goals of this Initiative to pilot and build a statewide PCMH collaborative for sustained transformation of safety net clinics The role of the executive sponsor was to oversee the learning community that supported the implementation of PCMH at partner clinics and to ensure that health policy supports the space for these clinics to test and apply change concepts that support attributes of PCMH The goal of the first year was Building working relationships across the existing medical home change efforts underway Integrating PCMH change concepts tools with locally emerging successful practices Finding effective ways to match clinic needs with varied approaches to practice consulting and knowledge transfer Assessing what works The strong foundation established in year one enabled us to use the national Project Team expertise and resources in years two through four for effective expansion of the scope and scale of the statewide learning collaborative The Executive Sponsor worked on health policy to provide the space for learning what works The goal was to ensure the right level of standardization of practice knowledge Policies were shaped to set performance requirements while encouraging innovation in matching care delivery processes

    Original URL path: http://www.safetynetmedicalhome.org/about-initiative/rcc/oregon (2016-04-30)
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  • Pittsburgh Regional Health Initiative | Safety Net Medical Home Initiative
    Turning its own community into a demonstration lab PRHI strives to accelerate improvement and set the pace for the nation Its experiment reflects three principles Healthcare is local federal policy changes alone cannot achieve needed reform Those who work at the point of care develop quality and safety improvements that work and last Continuous improvement in quality and safety requires the highest possible standard namely perfection to settle for less limits achievement PRHI offers healthcare leaders the necessary tools expertise education models and networks to perfect patient care and safety in their organizations Using the Toyota Production System as a model PRHI developed a quality improvement method for clinical settings known as Perfecting Patient Care sm Thousands across the nation have already learned how Perfecting Patient Care sm can transform healthcare Together they demonstrate the value of quality engineering in any healthcare setting from neighborhood clinics to hospitals and nursing homes PRHI is a nonprofit operating arm of the Jewish Healthcare Foundation with funding from local corporations foundations health plans and government contracts and grants Goals for the Initiative At the clinic level the primary goal of PRHI and our partner clinics was to realize improved patient outcomes quality of care delivery and patient and staff satisfaction via practice transformation to patient centered medical homes PCMHs To that end practice sites strove to Improve partnerships between patients and care teams Improve clinical outcome measures for patients with chronic diseases Increase knowledge of how to mine data to inform quality improvement efforts Improve teamwork to yield enhanced staff morale and patient care delivery Reduce avoidable hospital readmissions yielding improved patient care and a demonstrated return on investment Improve efficiency of care delivery processes Improve knowledge and skills related to quality improvement to decrease no show rates improve patient access and reduce

    Original URL path: http://www.safetynetmedicalhome.org/about-initiative/rcc/pittsburgh (2016-04-30)
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  • Change Concepts Overview | Safety Net Medical Home Initiative
    guide primary care practices through the PCMH transformation process Change concepts are general ideas used to stimulate specific actionable steps that lead to improvement Our framework includes eight change concepts in four stages Laying the Foundation Engaged Leadership and Quality Improvement Strategy Building Relationships Empanelment and Continuous and Team Based Healing Relationships Changing Care Delivery Organized Evidence Based Care and Patient Centered Interactions Reducing Barriers to Care Enhanced Access and Care Coordination Each Change Concept includes three to five key changes These provide a practice undertaking PCMH transformation more specific ideas for improvement The Change Concepts were derived from reviews of the literature and discussions with leaders in primary care and quality improvement They have been most extensively tested by the 65 safety net practices that participated in the SNMHI but they are applicable to a wide range of primary care practice types They have also been adopted by other improvement initiatives nationwide We created a set of resources and tools to help practices understand the framework and implement each of the eight Change Concepts These resources were developed in partnership with practices that participated in the SNMHI and were informed by reviewers and contributors from across the country All resources are in the public domain To learn about any one of the eight Change Concepts navigate to the relevant page by using the menu to the left To see all of the Change Concept resources and tools see the All Resources page General overview materials are provided below Change Concept Resources Introduction to the Safety Net Medical Home Initiative Implementation Guide Series In this introduction we describe the SNMHI s framework and how to navigate the library of resources and tools we created to help practices implement the PCMH Model of Care The Change Concepts for Practice Transformation Overview

    Original URL path: http://www.safetynetmedicalhome.org/change-concepts (2016-04-30)
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  • Engaged Leadership | Safety Net Medical Home Initiative
    for change and supporting and sustaining change efforts A key role of leaders during PCMH transformation is to identify and allocate resources to best support PCMH transformation needs Resources include time dollars staffing equipment technology and other types of support that either help staff implement or sustain PCMH key changes Engaged leaders are physically present throughout transformation and sustain staff energy and motivation by working with staff to identify and remove barriers to transformation Engaged leaders create a work environment supportive of PCMH transformation and give staff protected time and tools to make changes Key changes for Engaged Leadership Provide visible and sustained leadership to lead overall culture change as well as specific strategies to improve quality and spread and sustain change Ensure that the PCMH transformation effort has the time and resources needed to be successful Ensure that providers and other care team members have protected time to conduct activities beyond direct patient care that are consistent with the medical home model Build the practice s values on creating a medical home for patients into staff hiring and training processes Engaged Leadership Resources Implementation Guides Engaged Leadership Executive Summary Engaged Leadership Strategies for Guiding PCMH Transformation This Implementation Guide

    Original URL path: http://www.safetynetmedicalhome.org/change-concepts/engaged-leadership (2016-04-30)
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  • Quality Improvement Strategy | Safety Net Medical Home Initiative
    an essential part of QI Measurement provides feedback to staff providers leaders board members and patients about the organization s progress toward transformation and the outcomes of the care they provide or receive Health information technology HIT is part of the Quality Improvement Strategy Change Concept because quality improvement requires information HIT can help practices collect manage and report data accurately and efficiently providing care teams with the information they need to improve processes and outcomes Key changes for Quality Improvement Strategy Choose and use a formal model for quality improvement Establish and monitor metrics to evaluate improvement efforts and outcome ensure all staff members understand the metrics for success Ensure that patients families providers and care team members are involved in quality improvement activities Optimize use of health information technology to meet Meaningful Use criteria Quality Improvement Strategy Resources Implementation Guides Quality Improvement Strategy Executive Summary Quality Improvement Strategy Part 1 Tools to Make and Measure Improvement Part 1 provides an overview of QI and detailed information and case studies on two common QI methods the Model for Improvement and Lean Part 1 also covers the role of measurement in PCMH transformation and presents strategies for using data to drive and guide QI Quality Improvement Strategy Part 2 Optimizing Health Information Technology for Patient Centered Medical Homes Part 2 describes how practices can optimize health information technology in the context of a PCMH Tools A3 Type Report Template Do It Yourself Run Chart Cambridge Health Alliance Practice Improvement Team PIT Development Toolkit Measurement Strategy Worksheet Threshold Reference Table Webinars Spread and Sustainability in Medical Home Transformation December 19 2012 Moderator Nicole Van Borkulo MEd Qualis Health Speakers Mindy Stadtlander MPH CareOregon Robert Reid MD PhD Assoc Investigator Group Health Research Institute Audio video program Presentation slides Using Data for

    Original URL path: http://www.safetynetmedicalhome.org/change-concepts/quality-improvement-strategy (2016-04-30)
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