UMMS Affiliation

Commonwealth Medicine, Center for Health Policy and Research

Publication Date

2016-03-21

Document Type

Poster

Disciplines

Health Economics | Health Law and Policy | Health Policy | Health Services Administration | Health Services Research | Primary Care

Abstract

The Massachusetts Patient-Centered Medical Home Initiative (MA PCMHI) was a three-year multi-payer demonstration designed to promote clinical model transformation in practices across the state and prepare the practices for PCMHI recognition. It was a partnership between MassHealth, the Massachusetts Medicaid program, and UMass Medical School. An analysis of the project at 46 participating practices finds that primary care practice transformation takes time; care transitions, including emergency room and post-discharge follow-up care, require the development of new clinical workflows; and the processes of care are more likely to improve before outcomes are affected. These lessons learned can aid provider organizations nationwide: focus on highest-risk patients, prioritize high-volume hospital systems for information-sharing; streamline documentation of the workflow in the electronic health record; and clearly identify the role and function of each care team member in the new process.

Keywords

Patient‐Centered Medical Home, Health Care Reform, Medicaid, practice transformation, care coordination, clinical management, training, Massachusetts, MassHealth

Rights and Permissions

© 2016 University of Massachusetts Medical School

Journal/Book/Conference Title

Institute for Healthcare Improvement annual International Summit on Improving Patient Care in the Office Practice and the Community

Comments

Presented at the Institute for Healthcare Improvement annual International Summit on Improving Patient Care in the Office Practice and the Community.

Client/Partner: MassHealth

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