Skip to content

Posts tagged ‘NCQA’

2012 Integrative Healthcare Symposium: Emerging Opportunities within Healthcare Reform

Alison Greenberg, RN, BSN has a strong interest in integrative health care. She will be a contributing blogger for the CHMP. This is her first post for us.

Having had a long-standing appreciation for integrative medicine, I welcomed the opportunity to attend the 2012 Integrative Healthcare Symposium, held in NYC this past weekend.

The conference included the usual array of compelling messages by impressive speakers – including Jeffrey Bland, Dean Ornish, Leo Galland, Mimi Guarneri, Mark Hyman, Robert Rountree, Devra Davis and Joan Borysenko among many others. Common threads included the importance of healthy lifestyle (diet, exercise, social support), a close look at gut flora and its effects on the body and the growing knowledge base supporting mindful meditation.

In light of our ashamedly high healthcare costs coupled with the deafening federal deficit, Health Care Reform and the Affordable Care Act were also given significant attention by many speakers, including John Weeks, Kenneth Petellier, Susan Luck and  Dean Ornish. In fact, the ACA is colored with language referring to  “integrative health care” and use of “licensed CAM providers” throughout its contents.

Kenneth Petellier focused his entire talk on framing integrative approaches as monetary investments to fortune 500 companies – and viewing employee health as a valuable way to reach many people. He is currently conducting studies within corporate clinics to look at patient outcome and cost-benefits of integrative models over time.

John Weeks highlighted the integrative community’s ideal position to provide a much needed emphasis on prevention, health promotion and patient satisfaction. Holistic care promotes self care, self efficacy and can improve one’s ability to cope. Looking outside the pharmaceutical and procedural box, it also improves quality while lowering cost.

Many have imagined a world in which health providers got paid for their supposed goal – to elevate and maintain the health of the population. Now, for the first time, we may be in for a paradigm shift away from the billable fee-for-service visit. As the ACA’s payment structure kicks in that supports keeping people healthy, an integrative approach “will be an asset,” Says Ken Paulus of Allina, which cares for one third of Minnesotans.

In a system that devalues wellness and preventive care, the Patient-Centered Medical Home may serve as a useful model for integrative practitioners. PCMH’s are clinics that provide highly accessible, continuous and comprehensive care that focuses on healthy outcomes. More importantly, they are recognized by the NCQA (non-profit devoted to quality care) and PCMH status is quickly becoming a significant reimbursement label.

The PCMH model provides unassigned dollars that aren’t connected to a provider or a procedural code. You can use the money and distribute it within a practice as you wish.

Weeks focused on several healthcare center examples – including Tom Trompeter’s Healthpoint, a PCMH which has been using naturopathic doctors, acupuncturists, nutritionists, massage, and groups for 15 years and serves 65,000 patients a year in the Washington area.

Ira Zunin’s Manakai O’Malama Center in Honolulu, Hawaii is another great example of the PCMH’s ideal framework for an integrative setting – even when it includes unlicensed traditional healers. Zunin says of the integrative community: “we’ve always been looking at everything with a bigger tool set, with a focus on health. We are oriented to this model. We’re oriented to teams.”

There are definitely challenges ahead, as many still fight these policy reforms, and as providers attempt to gain PCMH status, but as a new nurse dedicated to holistic care, I was pretty inspired by this whole discussion.

Tomorrow – how does collaboration fit in?

NCQA Changes Medical Home Criteria

From Nationaal Archiefs Photostream

In 2009, 11 nurse-managed health centers applied for “patient-centered medical home” designation from the National Commission on Quality Assurance (NCQA). At the time, only NCQA granted that designation and having it meant that a health center or primary care practice could receive additional payments for coordinating the care of patients, particularly those with multiple chronic illnesses.

NCQA’s criteria for the designation were developed with the American Academy of Family Physicians and the American College of Physicians (NCQA’s governing board is chaired by John Tooker, CEO of the ACP). Not surprisingly, the criteria required that a medical home be led by a physician. The 11 nursing-managed centers are led by nurses, although they include physicians as consultants or members of interdisciplinary teams. They were told by NCQA that they met all of the criteria–except that they were not physician directed. They were not given the designation.

In 2010, The Joint Commission announced that it is developing standards to accredit ambulatory health care organizations as “primary care health homes.” The change in language from “medical” to “health” homes conveys a shift in thinking about whether we’re focused on promoting health or simply treating diseases. I have been told that the standards developed by The Joint Commission will not include that a practice be lead by a physician.

So the handwriting may have been on the wall for NCQA as this new competition has emerged. They have reversed their position on the nurse-managed centers that had applied for medical home designation. NCQA has granted the designation to eight of these centers in Pennsylvania that are mostly safety net providers to underserved populations and have outstanding clinical outcomes. These centers are Project Salud of La Comunidad Hispana; Eleventh Street Family Health Services of Drexel University, Health Anned, and Abbottsford Falls Family Practice and Counseling of the Family Practice and Counseling Network; PHMC Health Connection, Rising Sun Health Center, and Mary Howared Health Center of Public Health Management Corporation; and the Children’s Health Center of VNA. All are members of the National Nursing Centers Consortium.

Diana J. Mason, PhD, RN, FAAN, Rudin Professor of Nursing

Follow

Get every new post delivered to your Inbox.

Join 7,953 other followers

%d bloggers like this: