This document provides an overview of the patient-centered medical home (PCMH) model including its history and evolution, the role of the National Committee for Quality Assurance (NCQA) in recognizing PCMHs, and opportunities for health centers under the Health Resources and Services Administration (HRSA) to implement the PCMH model with support from HRSA.

1. Patient-Centered Medical Home: The Call to Action Adele Allison National Director of Government Affairs

4. PCMH Evolution Timeline AAP establishes “Medical Home” Concept “ Medical Home” evolves to provide primary care as a community HI places the “Medical Home” into its Child Health Plan Surg. Gen’l holds 1 st major conference for Children with Special Health Care Needs (CSHCN) AAP holds first “Medical Home” Conference AAP publishes policy statement defining “Medical Home” 7 U.S. Family Med. Org. publish “Future of Family Medicine” stating every American should have a “ personal medical home” ACP develops its “Advanced Medical Home” model AAFP, AAP, ACP, and AOA release the “Joint Principles of the PCMH” 20 Bills promoting the “Medical Home” introduced in 10 states PPACA is signed into law incorporating the “Medical Home” into CMS’ establishing Accountable Care Org. (ACOs) 1967 1978-79 1987 1989 1992 2002 2005 2007 2009 2010

8. Funding Medicare

9. Unemployment & States 1% Increase in National Unemployment Rate ═ Decrease in State Revenue 3-4% + 1M Increase in ‘Caid and CHIP Enrollment 1.1M Increase in Uninsured

10. U.S. Medicaid - Present Health Insurance – 58M 29M Children, 15M Adults, 14M Elderly & Disabled Asst. to ‘Care Beneficiaries – 8.8M 8.8M Aged and Disabled (21% of Medicare) Long-Term Care – 3.8M 1M Nursing Home, 2.8M Community-based Residents Support for Healthcare and Safety Net 16% of nat’l spending; 41% of LTC services State Capacity for Health Coverage Federal share 50%-76%; 44% of all Federal funds to states Source: Kaiser Permanente Commission on Medicaid 2010

11. Health Care Spending & GDP

12. Health Care Spending & GDP Source: OEDC Health Data – Total Expenditures as % of GDP

14. PCP Shortage

26. PPACA – Legal & Policy Supporting PCMH PPACA or Reconciliation Act Section Opportunity Description Effective Date PPACA § 1139B Reporting Adult quality health measures for Medicaid-eligible adults through a Medicaid Quality Measurement Program. CY 2013 PPACA § 3015, 10305 Reporting Grants for data collection and other public reporting requirements FY 2010 - 2014

29. NCQA PCMH 2011 Scoring Points NCQA PCMH 2011 Standard and Element Number of Factors Must Pass? 20 PCMH Standard 1: Enhance Access and Continuity 34 4 Element A: Access during office hours 4 Yes 4 Element B: Access after hours 5 No 2 Element C: Electronic Access 6 No 2 Element D: Continuity 3 No 2 Element E: Medical Home Responsibilities 4 No 2 Element F: Culturally & Linguistically Appropriate Services (CLAS) 4 No 4 Element G: Practice Organization 8 No 17 PCMH Standard 2: Identify and Manage Patient Populations 35 3 Element A: Patient Information 12 No 4 Element B: Clinical Data 9 No 4 Element C: Comprehensive Health Assessment 10 No 5 Element D: Using Data for Population Management 4 Yes 17 PCMH Standard 3: Plan and Manage Care 23 4 Element A: Implement evidence-based guidelines 3 No 3 Element B: Identify High-Risk Patients 2 No 4 Element C: Manage Care 7 Yes 3 Element D: Management Medications 5 No 3 Element E: Electronic Prescribing 6 No 9 PCMH Standard 4: Provide Self-Care and Community Support 10 6 Element A: Self-Care Process 6 Yes 3 Element B: Referrals to Community Resources 4 No 18 PCMH Standard 5: Track and Coordinate Care 25 6 Element A: Test Tracking and Follow-up 10 No 6 Element B: Referral Tracking and Follow-up 7 Yes 6 Element C: Coordinate with Facilities / Care Transitions 8 No 20 PCMH Standard 6: Measure and Improve Performance 22 4 Element A: Measures of performance 4 No 4 Element B: Patient / Family feedback 4 No 4 Element C: Implements Continuous Quality Improvement 4 Yes 3 Element D: Demonstrates Continuous Quality Improvement 4 No 3 Element E: Performance Reporting 3 No 2 Element F: Report Data Externally 3 No 100 149 6

39. To learn more about the Patient-Centered Medical Home, visit: http://www.successehs.com/category/patient-centered-medical-home.htm