The collaboration between Community Care of NC, AccessCare of the Blue Ridge, and the Appalachian State University School of Health Care Management was again honored by being asked to help shape the future of the NCQA’s (National Committee on Quality Assurance) Patient-Centered Medical Home model (PCMH).
Community Care of NC is a state-wide, NC-based, provider-led organization that serves over 1.4 million Medicaid patients in our state.
The new project came about through the efforts of one of the ASU students, Daniel Gibbs, who in his final term paper for the “Practicum in Primary Care” last semester wrote about the disparity between the resources that small, rural, particularly independent practices have when compared to practices that are part of larger systems (that is, hospitals or large regional healthcare conglomerates). In his paper, he outlined the need to have a different set of standards for smaller practices compared to the larger ones with more resources.
The program leadership encouraged Daniel to send in his thoughts and comments to NCQA for consideration. Never thinking he, a “mere” student, would hear back from such a large and auspicious organization, he was reluctant to send in his paper. And yet, a short two weeks later he heard back from NCQA. After listening to Daniel’s experience with the Practicum and they types of practices that were being served, they asked if any of “his” practices would consider being part of a pilot project NCQA was doing around specifically looking at the needs of smaller practices.
At this point, CCNC/ASU Practicum in Primary Care has enrolled 6 practices in the Boone area (High Country Community Health (sites in Watauga and Avery Counties), Greenway Family Medicine, Blowing Rock Medical Clinic, Mountain Laurel Internal Medicine, and Mountain Laurel Family Medicine, and Ashe Pediatrics) to participate in the pilot. These 6 practices are part of the 27 practices across the country who have been asked to join the pilot and are the only ones in NC. In addition, they are the only rural practices participating in the program.
These practices will help NCQA develop a new system that will include more guidance including live support, online resources, and improved customer service. They will participate in streamlined annuals “check-ups” for recognized practices instead of the full documentation that is currently done every 3 years. The new program hopes to be even more clinically relevant than the current program. What is learned from these pilot practices will influence the development of the newest generation of NCQA PCMH Standards and Guidelines that will come out in 2017.
The student program has helped many more practices in the High County achieve NCQA PCMH recognition over the past 4 years. In fact, many of these practices have stated they could not have obtained their recognition status without the help of the students. The Practicum and its students help provide rural practices much needed support for all the changes coming to medicine in the 21st century.
One of the practices that have been assisted by the student program is Granite Falls Family Medical Center owned by Ed Bujold, MD, a family physician. Dr. Bujold recently wrote an article in the Annals of Family Medicine1 where he outlined some of the changes that should take place in the PCMH recognition model.
Dr. Bujold stated, “Seeing patients used to be the hardest part of my job. It is now the easiest by a long shot.” He goes on to state the physical, mental, and financial toll it takes for small practices to “keep up” with all the changes, reports, and certifications, etc. that are required these days to keep the doors of the practice open in order to see the patients that need to be seen.
That “prime directive” for a practice can sometimes get lost with all the documentation and reporting to various entities that must be done. Overall, Dr. Bujold states that being PCMH has transformed his practice in many positive ways, but not without a heavy cost on his life and his practice. Hopefully the changes that the practices involved with the CCNC/ASU student program will bring about in NCQA’s recognition process described above will help the process become more valuable to smaller practices and the patients they serve.
In the broader picture, Community Care of NC’s Medical Home model for our state’s Medicaid recipients continues to save NC hundreds millions of dollars per year. In fact, for every dollar invested in CCNC saves 3 dollars for the state’s taxpayers. It should be noted that all those savings stay within NC. This was proven once again by the recent state auditor’s report. That should be remembered in any effort that moves toward meaningful Medicaid reform. NC should retain CCNC’s medical home model to ensure quality care and continue these savings for our state’s most vulnerable population.
The Community Care of NC/ASU student program was the 2014 recipient of the “Innovations in Rural Health Award” by the Kate B. Reynolds Charitable Trust and has recently been awarded an over $700,000 grant from KBR to expand the program across the state starting with East Carolina University in Greenville, NC.