New Report: Integration of Oral Health and Primary Care Practice

We are pleased to pass along this email message received today from the Virginia Oral Health Coalition:

In response to the need for improved access to oral health care, the Health Resources and Services Administration (HRSA) developed the Integration of Oral Health and Primary Care Practice (IOHPCP) initiative. Coalition staff and board members were invited participants in the stakeholder group which helped develop these recommendations.

The resulting IOHPCP report reaffirms the Coalition’s message that oral health is a necessary component of primary care and outlines simple steps for integration, including:

  • Apply oral health core clinical competencies, such as oral health assessments, within primary care practices;
  • Develop an infrastructure that enhances adoption of the oral health core clinical competencies and acts as a conduit for interprofessional care; and
  • Modify payment policies to efficiently address the costs of implementing oral health competencies and provide incentives to health care systems and practitioners.

If you’re interested in more information about oral health and primary care integration (academic or clinical settings), please contact Sarah Bedard Holland at 804.269.8721 or The Coalition has a menu of resources for large- or small-scale integration.

Read the full report

Structuring Payment to Medical Homes After the Affordable Care Act

This research brief from the Commonwealth Fund summarizes findings and recommendations from a recent study by Harvard Medical School’s Samuel T. Edwards and colleagues as published in the Journal of General Internal Medicine.  Edwards et. al. conclude that patient centered medical homes (PCMHs) and accountable care organizations (ACOs) are complimentary approaches, and the authors recommend specific payment approaches for integrating PCMHs with ACOs.

Read the full Brief at the Commonwealth Fund website.

Marketplace Virginia Proposal

The document at this link presents a report from the Senate Finance Subcommittee on Health and Human Resources dated February 16, 2014.  This document contains a description of the Marketplace Virginia proposal.  Please note that this proposal is subject to change as the General Assembly continues its work.


Updates from the National Medical Home Summit

The Sixth National Medical Home Summit is being held in Philadelphia from March 17-19. The Summit is co-hosted by the Patient-Centered Primary Care Collaborative (PCPCC), and brings together the leading authorities and practitioners in the medical home field to discuss how it is working, where it has proven outcomes, what lessons have been learned, where it needs improvement, and what issues and challenges lie ahead. There are a few take-aways so far from the Summit:

  • PCMH is a strategy for population health management being utilized by primary care practices, specialty practices, and health systems.
  • The medical home model is about more than recognition (NCQA PCMH or otherwise) – rather it is about sustained practice transformation.
  • To be a true PCMH, the practice must engage with its “neighbors” in a Patient Centered Medical Neighborhood.
  • To be successful, PCMH practices must engage patients in their care and employ strategies for behavior change.
  • Ask the question “Is PCMH helpful?,” rather than “Is PCMH perfect, ” when evaluating the model.
  • To effectively speak about whether there are cost savings with the PCMH model, the practice/system should be utilizing cost incentives.
  • PCMH collaborations are going on all around the country, many involving ACOs, shared information systems, enhanced payment structures, involvement of health systems and specialists, and safety net organizations.
  • Practices pursuing PCMH development should consider behavioral health integration models backed by a sound strategy and purpose for integration. This may include a behavioral health consultant, psychiatrist, or social worker.
  • Safety net organizations often serve those populations who are most vulnerable and who are affected by multiple conditions. The PCMH model is particularly effective and important for these populations. Thus, despite the challenges encountered in safety net organizations, there are many applications of the PCMH model in these organizations across the country.

Commonwealth Coordinated Care

Commonwealth Coordinated Care is a new initiative to coordinate care for individuals who are currently served by both Medicare and Medicaid and meet certain eligibility requirements.  It is an important component of the Virginia Medicaid innovation agenda, and it is one example of the national movement toward more integrated systems of care for Medicare and Medicaid enrollees.  According to the DMAS website:

The program is designed to be Virginia’s single program to coordinate delivery of primary, preventive, acute, behavioral, and long-term services and supports.  In this way, the individual receives high quality, person centered care that is focused on their needs and preferences.

The goals of this initiative include: improved quality and health outcomes, streamlined Medicare and Medicaid requirements, increased accountability, reduced burden for enrollees and providers, providing care in each individual’s setting of choice, and reduced avoidable services. Supplementary benefits will include care coordination, interdisciplinary care teams, and person-centered care plans.

Click here to learn more about Commonwealth Coordinated Care at the DMAS website.


Three Main Types of Quality Measures

When developing a quality strategy it is helpful to remember that there are three main types of quality measures that should be considered: process measures, outcome measures, and structure measures.  The following definitions are based on information provided by the AHRQ National Quality Measures Clearinghouse.

  • Process Measures.  A process of care is a health care related activity performed for, or on behalf of, a patient.  Process measures are supported by evidence that the clinical process – that is, the focus of the measure – has led to improved outcomes.  An example of a process measure would be the percent of patients with hypertension who received timely blood pressure screens.
  • Outcome Measures.  An outcome of care is a health state of a patient resulting from health care.  Outcome measures are supported by evidence that the measure has been used to detect the impact of one or more clinical interventions.  An example of an outcome measure would be the percent of patients with hypertension whose blood pressure is under control.
  • Structure Measures. Structure of care is a feature of a health care organization or clinician related to the capacity to provide high quality health care.  Structure measures are supported by evidence that an association exists between the measure and one of the other clinical quality measure domains.  An example of a structure measure would be whether the health care organization maintains a register of patients with established hypertension.

Some organizations recommend two additional categories of measures including patient experience measures and access measures.  However these types of measures are not as widely used, and they may also be included as appropriate under one of the three main categories outlined above.

Focusing on PCMH development, the PCMH model is based on recommended practices for the structure of health care.  In this context, implementation of the PCMH standards and elements can be viewed as structural indicators of quality.


AHRQ Innovations on Community Initiatives to Enhance Access for Vulnerable Populations

The February 12 issue of the Agency for Healthcare Research and Quality (AHRQ) Health Care Innovations Exchange ( focuses on community-wide initiatives to enhance access for vulnerable populations.

The featured Innovations describe three community-wide initiatives that seek to increase access to health care for vulnerable populations. The programs include

  • A community collaborative that opened a free clinic for uninsured children and implemented targeted interventions for patients with sickle cell anemia and substance abuse issues (click here);
  • A community-funded, nonprofit organization that matches eligible uninsured and underinsured patients with providers who agree to serve them at a discounted rate (click here); and
  • A school-based, collaborative, community-wide program that provides mental health and other support services to students and their families living in neighborhoods plagued by poverty and crime (click here).

The featured QualityTools include

VHCF Webinar Series on Psychiatric Disorders in Primary Care

This webinar series was developed by VHCF to provide continuing education for health care professionals who provide primary care to individuals with mental health conditions, and may not have mental health specialists available either onsite or in the community.

Based on the priority needs identified in an April 2013 survey of Virginia’s safety net medical directors conducted by VHCF, two modules were developed: Pharmacotherapy for Psychiatric Disorders in Primary Care, and Diagnostic Considerations for Psychiatric Disorders in Primary Care. Each module is approximately 1.5-2 hours in length, and the cost to register is $25/webinar.

In addition to physicians, nurse practitioners and physician’s assistants, other health professionals who may be interested include pharmacists, dentists, psychologists, licensed clinical social workers, licensed professional counselors and registered nurses.  Both webinars are approved for CME credit, and thePharmacotherapy for Psychiatric Disorders in Primary Care module also is approved for ACPE credit.

Click here for more details on this webinar series.

PCMH and Healthy People 2020

Within the Collaborative we have been discussing the impact of the PCMH model on direct patient care and on the broader health of the community.  Healthy People 2020 provides one lens for examining the connections between PCMH and community health improvement.  We have recently posted an article that provides an overview of Healthy People 2020 and draft framework for linking the PCMH model to Healthy People 2020 objectives.  We welcome your ideas for improving this framework.  Click here to read the article and view the framework.


Process of Care Compliance is Associated with Fewer Diabetes Complicatons

Evidence-based research tells us that a quality health system must focus on positive health outcomes and process measures. However, few studies to date have examined the relationship between quality process measures and long-term reductions in disease complications. This recent article published in the American Journal of Managed Care finds that patients with diabetes who received proper and complete testing experienced fewer complications in the long term.  In fact, study authors stated that those who showed the fewest complications in the long term were those who were considered sickest at the start of the study. The study used a composite measure approach, where quality of care was measured as patients with diabetes who received all three process measures: glycated hemoglobin (HbA1c), lipids, and microalbuminuria.

Click here to read the full article.