Evidence-level

Promising (About evidence-level criteria)

Description

Community Care of North Carolina (CCNC) received funding in 2011 from the Centers for Medicare & Medicaid through the MAPCP (Multi-payer Initiative). CCNC used the grant funds to help primary care practices in North Carolina develop the medical home model more fully. A large part of this endeavor was to help primary care practices achieve Patient Centered Medical Home (PCMH) Recognition through the National Committee for Quality Assurance (NCQA).

Because of the amount of work involved, Access Care of the Blue Ridge, a network within CCNC, reached out to Appalachian State University to pair undergraduate healthcare management majors with primary care practices. The PCMH Practicum in Primary Care was born, giving students hands-on experience in rural healthcare administration and helping primary care facilities achieve PCMH Recognition Blue Cross Blue Shield's Blue Quality Physician Program Recognition (BQPP).

While Appalachian State University's Beaver College of Health Sciences students were the first to participate in the program, it expanded to East Carolina University and McDowell Technical Community College.

In 2012, the PCMH Practicum received a Blue Cross Blue Shield of North Carolina Foundation grant that provided stipends for students and financial support for the program. In 2014, the program was winner of the Kate B. Reynolds Charitable Trust Innovations in Rural Health Award, recognizing innovative ideas to improve the health of people living in rural North Carolina communities. Due to the ending of grant funds, the PCMH Practicum will not continue.

This video, produced by the Kate B. Reynolds Charitable Trust, shares the impact of the program:

Services offered

A syllabus was developed for each PCMH Practicum semester and included weekly instructions that equipped students in the following:

• Learn the NCQA PCMH recognition process standards.
• Educate rural practices about the PCMH recognition process.
• Identify a team of "PCMH Champions" within the practice to work on the PCMH recognition process.
• Document workflows within the practice, make suggestions for improvement, and help write policies and procedures for the rural practices.
• Help practices participate in the BQPP initiative, a program that rewards physicians for steps to further improve the quality of their care.
• Help practices choose quality improvement strategies to address gaps in care for the practices.
• Technology training and improved skills working in electronic medical records (EMRs), registries and spreadsheets, etc.
• How to accurately collect, measure, and report data
• Participate in experiential quality improvement labs and pharmacy labs

The Practicum in Primary Care team matches students to practices that give them experiences in their desired field of study. They also provide mentoring and support for each individual student as well as attending didactic sessions about PCMH, quality improvement, and workflows, etc. Students also attend community meetings to learn about the medical neighborhood's challenges and meet other healthcare professionals.

Results

From 2012-2018, the PCMH Practicum saw the following results:

• 110 student participants
• 28 primary care practice participants
• 15,644 Medicaid patients served
• 93,986 total patients served

Presentations on the PCMH Practicum have been shared on a national level at NCQA's PCMH 2015 Congress and the Institution for Health Care Improvement's 26^th and 27^th Forum.

The following journal publications provide more information about the PCMH Practicum:

Sasnett B., Watkins R.W., Ferlazzo M. (2017). Health Service Management Interns Serve as Practice Facilitators for Patient-Centered Medical Home Recognition: East Carolina University-Appalachian State University Initiative. The Health Care Manager, 36(1) 96-103. Article Abstract.

Lane S.J., Watkins R.W. (2015). Using a Facilitation Model to Achieve Patient-centered Medical Home Recognition, The Health Care Manager, 34(2) 93-105. Article Abstract.

Lane, S. (2014). Measures of Student Competence Following Participation in a Patient-Centered Medical Home Demonstration Project-Practicum in Primary Care. The Journal of Health Administration Education.

Lane S.J., Watkins R.W. (2013). Helping Primary Care Practices Attain Patient-centered Medical Home (PCMH) Recognition Through Collaboration with A University. Journal of the American Board of Family Medicine, 26(6), 784-786.

Watkins, RW. (2012). Partnering with Universities And Colleges to Facilitate the PCMH Process. An Innovative Plan to Place Healthcare Management Students Into Practices to Promote Healthcare Transformation. The Journal of Medical Practice Management, 28(2), 134-6. Article Abstract.

Challenges

In order to participate in MAPCP, practices had to attain PCMH status, but most lacked the resources to pursue NCQA recognition. Few primary care practices in these counties had begun the transformation to EMRs and could not meet PCMH requirements for e-prescribing or attaining meaningful use.

The PCMH recognition process is time-intensive, requiring an estimated 100-200 hours of time to complete the application. Most applications must contain 120-150 documents. For smaller, rural primary care practices, it can be difficult to allocate adequate staff time to gain PCMH recognition.

Replication

Rural practices interested in achieving NCQA or BQPP can start a practicum program in order to gain assistance in their goals. A good place to start is by reaching to a post-secondary institution that has a healthcare management program, a college of health sciences, school of healthcare management, school of public health, a medical school, or a nursing school.

Because the time needed to run this practicum is extensive, getting a commitment can be a struggle because those working in rural practices are already spread thin. Securing a provider champion, office manager, and other staff who will be working closely with the students is foundational. It will be necessary to regularly meet with these people to hear their concerns, support, and educate them on the processes. Patients and persistence are key.

The goal of the program was less about checking boxes and more about applying the tenets of population health management. This made a difference in the way patients were treated and improved health outcomes.

Contact Information

R.W. "Chip" Watkins, MD, MPH, FAAFP, Senior Medical Director
CareReach (formerly Community Care of Western North Carolina)
828.279.6770
nutramd@aol.com