Ohio Health Quality Improvement Plan

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Appendix IV — Co m m e n t s f r o mStatewide Or g a n iz a t io n s• Patient and physician education on GI health andappropriate use of antibiotic medications• Diabetes handbookOhio Academy of Family PhysiciansOhio Academy of Family Physicians (OAFP) will beworking over the next three months to develop its 2010-2013 strategic plan that includes these strategies and tactics,which are already priorities for the Academy. OAFP wouldbe able to assist in implementation of all these strategiesthrough work on any task forces or committees to helpeducate and communicate with Ohio’s family physicians.The top priority for the Council should be to educateprimary care physicians on what the patient-centeredmedical home (PCMH) is; how physicians can transformtheir practices into PCMH; and provide information onthe Ohio health information network to assist physiciansin the electronic health record (EHR) conversion. Thisshould take place while payment reform is addressedcorresponding with the PCMH.The four collaborative transformation strategies can beintegrated by focusing on the primary care system:• Primary care physicians will become PCMH witheducation on how to transform their practices andwill also move forward with the EHR conversionbecause it is part of the PCMH and will be willing tomove forward once a health information exchange isestablished• Payment reform will be accomplished with the34integration of PCMH. It is imperative that paymentreform play a paramount role in practice transformationtoward PCMH integration. Without this critical piece ofthe PCMH principles, primary care education and othercollaborative efforts will fail to reach desired outcomes.There will be informed and activated patients and•individuals through effective use of PCMH.Ohio Association of Advanced PracticeNursesThe Ohio Health Quality Improvement Plan offers acohesive and all encompassing proposal to reform Ohio’shealth system. Advanced Practice Nurses currently provideprimary care services to tens of thousands of Ohio’scitizens. We are experienced in the provision of wellnessand chronic care medical services and prepared to take partas leaders and members of the Patient Centered MedicalHome initiatives in Ohio.Patient Centered Medical HomeImplementation of the patient centered medical home ismost crucial to real health care reform. The realization ofthis model of care delivery requires the integration of all ofthe other transformational strategies including IT, PaymentReform, and the Activated Patient. Changes in access andaffordability can be greatly accelerated through the PCMHmodel. The Ohio Association of Advanced Practice Nurses,(OAAPN), can assist in providing outreach, education andassistance to APNs in pursuing the PCMH model in theirown health care practices.Payment ReformPayment reform will be elusive, contentious and mostdifficult to pursue since all interested stakeholders arestriving to proceed as they always have in their own selfinterest. Ohio’s managed care organizations, public andprivate insurers, hospitals, and physician trade associationshave demonstrated their power and influence with Ohio’slegislators in eliminating all budget bill provisions thatcould have promoted cooperation. Is payment reformlikely in such a politically hot environment? Possibly, butit won’t be easy. APNs can be found in independent APNpractices, physician provider and hospital based practices,long term care practices, retail and employer based clinics,and in other settings. Their investment in the status quo isless than most other providers since they are currently paidless for providing similar services with very high quality.The question that must be asked is “Why insurers wouldwant to continue to pay more when they could pay less andget a high quality service?”Council PrioritiesThe top priority for the council should be to proceed withthe implementation of the PCMH for the underserved,underinsured and the poor in Ohio. Insurance coveragewithout access is not coverage however and all barriers thatprevent health providers from practicing to the fullest scopeof practice should be removed.OAAPN can assist with the implementation of the PCMHin member practices, assist with needed education of Ohio’sAPNs regarding PCMH and encourage APNs to enter theprimary care workforce.OAAPN is also committed to serving on health care policycommittees whose purpose is to pursue positive change inthe delivery of health care services to Ohio’s citizens.
Appendix IV — Co m m e n t s f r o mStatewide Or g a n iz a t io n sOhio Association of Area Agencies onAgingThank you for the opportunity to comment on the OhioHealth Quality Improvement Plan as it relates to thestrategy entitled Patient-Centered Medical Home. TheOhio Association of Area Agencies on Aging (OAAAA)supports this strategy as a central focus area in home andcommunity-based case management and waiver services.For over thirty years, Ohio’s Area Agencies on Aginghave been a leader in the long term care industry by beingcommitted to meeting the chronic care needs of a growingaging population. Area Agency on Aging 10B (AAA 10B)has been in the forefront of advancements in improvingconsumer care and we highlight their excellent work as anillustration of coordinating care across various segments ofthe health care system.AAA 10B has utilized an approach and integrates caredelivery with the initial assessment which transitionsto case management with continuous, comprehensive,coordinated care, as a partnership between consumers andtheir health care team. The medical home will emphasizescoordinated and/or integrated care across all elements ofthe complex health care system; enhance access to makeit easier for members to contact their personal health careteam; improve quality and safety by promoting prevention,proactively managing chronic illness, engaging members intheir care, and using our electronic systems for support.AAA 10B has partnered with 7 regional hospitals andlocate Long Term Care Nurse Consultants on eachcampus. This initiative began in 2000 to effectuate theshift in focus toward a more comprehensive, holisticcare and incorporates the characteristics associated withboth lower costs and better outcomes. In the last 2 years,AAA 10B has provided long term care consultant visitsto 5000 individuals per year with plan development forcommunity arrangements to meet their chronic care needs,with enrollment in a program or receipt of other communityservices. This coordinated care is across all elements ofthe member’s community, including the physician, hospitalteam, nursing home, home health agencies, and othercomponents of a complex health care system—includinghealth information exchange to assure the indicated care isattained when and where it is needed.AAA 10B enhances clinical staff skill set in order tomitigate the impact of risk factors for members at highrisk of nursing facility placement. AAA 10B has workedclosely in partnership with SummaCare MedicareAdvantage Plans and are actively pursing other health plansfor the integration of health plans with our communitybasedbenefits in order to promote community-based care isintegrated and coordinated, in addition to quality and safetyas hallmarks. AAA 10B’s partnership improves enhancedaccess to dual members by system advances and newcommunication options between partners.Additionally, AAA 10B conducts a weekly caremanagement interdisciplinary team (CMIT) meetingwhich includes a physician with geriatrics specialty,staff care managers, staff Clinical Nurse SpecialistSupervisor, and representatives from the communitythat may include hospice, direct care providers, adultprotective services, local housing coordinators, and visitingpharmacists. CMIT aligns efforts for integrated caredelivery and mitigates the community resources with thehealth system for productive interactions which improvemember’s functional and clinical outcomes. The member’sprimary care physician collaboration occurs throughcommunication from the team meeting discussion andwritten updates. Member outcomes that occur from theresult of the CMIT care conference may be arrangementsto referrals to physician specialists, revision of AAA 10Bcare plan services, housing relocation assistance, outpatientutilization, chronic disease management training, andaccessing medical care appropriately and timely with theinvolvement of the case manager.Finally, AAA 10B continues to add clinical staff to bolsterour proficiency in managing chronically impaired olderadults. Building on our addition of our PASSPORTClinical Nurse Specialist AAA 10B began the initiativeof adding Registered Nurse High Risk Care Managers tohelp our most vulnerable members better manage prevalentmedical risk factors to minimize the risk of permanentnursing facility placement.Ohio Association of Health PlansThe Ohio Association of Health Plans (OAHP) appreciatesthe opportunity to participate with other stakeholders,through HQII, to discuss strategies for creating a highquality,cost-effective, high performing health system inOhio. I commend all those that participated in the processand the time many dedicated to capture their input anddevelop the final document. I believe this has been a35
Page 1 and 2: Ohio Health QualityImprovement Plan
Page 3 and 4: Introduc tionIn November 2008, more
Page 5 and 6: In t r o d u c t io nimplementation
Page 7 and 8: Oh io He a l t h Qu a l it y Im p r
Page 9 and 10: Pa t ie n t Centered Me d ic a l Ho
Page 11 and 12: Pa t ie n t Centered Me d ic a l Ho
Page 13 and 14: He a l t h In f o r m a t io n Te c
Page 15 and 16: Pa y m e n t Re f o r m◦◦◦◦
Page 17 and 18: In f o r m e d a n d ActivatedPa t
Page 23 and 24: Me a s u r in g Su c c e s sPropose
Page 25 and 26: Ne x t StepsOhio Health Care Covera
Page 27 and 28: Appendix II — Response to Questio
Page 29 and 30: Appendix III — Su r v e y Results
Page 31 and 32: Appendix IV — Co m m e n t s f r
Page 33: Appendix IV — Co m m e n t s f r
Page 45: CORE PLANNING TEAMAmy Rohling McGee

Ohio Health Quality Improvement Plan

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