In our current era of health care reform, pediatricians and other primary care providers are being asked to create patient-centered, cost-effective pediatric practices and to participate in ongoing quality improvements of their health care processes—in addition to caring for children. Chapel Hill Pediatrics and Adolescents, a 12 MD private practice in North Carolina, is trying to address this challenge through collaborative efforts with the State of NC, Medicaid, and BCBS of NC Foundation.
With a grant from BCBS Foundation in 2003, CHPA represented North Carolina in NICHQ's first Medical Home Learning Collaborative, working with 13 other states to develop clinical practices that supported the Medical Home concepts, particularly for children with special health care needs. The practice developed a clinical registry, collated a local resource directory of services for CSHCN, and began care-coordination services for 3 hours a week. NC Title V helped continue the quality improvement process with a 3 year grant around Medical Home Implementation for CSHCN. CHPA collaborated with Medical Home pioneers across the state to share new ideas and tests of change in the clinical setting, and served as a demonstration project for new clinical processes. A new partnership was developed with Carolina Access, NC's Medicaid Managed Care program, providing a small per-member/per month fee to help sustain the enhanced access, communication, and patient support. CHPA reviewed its own coding practices and carefully renegotiated insurance contracts, using data generated from their work in the Learning Collaborative to document the cost-saving nature of the Medical Home.
By 2006, the physicians and families of CHPA were convinced that such planned care, care-coordination, and self-management support were non-negotiable, and sought other funding opportunities to continue their quality improvement. Since data from their initiatives had shown cost savings to insurers, BCBS of NC invited CHPA to participate in their pilot "Pay-for-Performance" program, Bridges to Excellence. Using the standards developed by NCQA and their survey tool, the practice underwent a step-by-step delineation of their policies, practices and outcomes. This meticulous exercise demanded that CHPA hire an MD/MPH student over a 6 month period to collect the data for the survey tool. Two of the pediatricians, the care coordinators and other staff met weekly with this (spectacular!) student to identify and describe CHPA processes around such areas as patient access, communication, test tracking and referrals. After data submission and intensive review by NCQA, the practice achieved Level 2 NCQA certification and received a financial award from Bridges to Excellence. The BCBS BTE financial support will permit the practice to continue care coordination services and quality improvement efforts.
In 2007, CHPA instituted EMR, which will potentially facilitate a higher level of Recognition with NCQA. Chapel Hill Pediatrics and Adolescents intends to continue their efforts toward a Patient-Centered Medical Home and to pursue ongoing NCQA Recognition. These efforts, though, are time and labor intensive and will not occur without financial support from insurers, employers, and the governing health-care bodies. Recognition of and compensation for such efforts by insurers, however, will be essential to encourage very busy practitioners to sustain such Quality Improvement initiatives.
1 Physician Practice Connections® and PPC® are registered trademarks of the National Committee for Quality Assurance. Physician Practice Connections®-Patient-Centered Medical HomeTM and PPC®-PCMHTM are trademarks of the National Committee for Quality Assurance.
2 NCQA’s PPC-PCMH Program is an evidence-based program that encourages and recognizes physician practice quality. Recognition under the PPC-PCMH Program may result in monetary rewards from third parties, such as purchasers, plans or others tied to quality. NCQA neither recommends nor decides whether or to what extent a physician practice should or will receive such rewards.