SustiNet Health Partnership

Medical Home Advisory Committee

Medical Home Advisory Committee Regular Meeting

November 18, 2009

Meeting Minutes

Committee Attendees:  Ellen Andrews, Co-chair; Tory Westbrook, Co-chair; Tom Woodruff; Sheldon Toubman; James Stirling; Margherita Giuliano; Domenique Thornton; Jim Augur; Sylvia Kelly; Bruce Gould; Amy Casavina Hall; Jack Serafin; Rick Duenas; Judith Meyers; Jody Terranova; Jim Cox-Chapman; Drew Morton; Ken Lalime

Note:  This committee’s membership is not yet finalized

Office of the Healthcare Advocate:  Vicki Veltri

Ellen Andrews welcomed the committee members and stated that she’d like to discuss the charge for the committee.  She said that the charge for this committee is to research and develop patient-centered medical homes, what the model is and isn’t, where CT is and where CT needs to be in terms of being able to implement them, what resources are needed to make this happen, and to make recommendations by July to the SustiNet board.  Everything that is done here will be posted on the SustiNet website; all of the meetings will be transparent; all of them will be subject to Freedom of Information laws; all meetings are being recorded, and minutes will be posted online.  The committee is hoping to invite national experts to speak to provide information on what’s happening in other states and on the national level.  An unidentified speaker brought up the list of expectations that was sent by the chairs of the SustiNet board.  The committee’s goal is to reach a consensus on recommendations to the board that will then make recommendations to the legislature.  She said that the committee wants to be sure that everyone who should be here is included and that all are on the same page.  She asked that anyone come forward with suggestions. 

An unidentified speaker said that this is an opportunity to take some of the models seen on the national level and replicate those efforts here in CT.  He said it’s also a chance to create something new, so that others may emulate CT.   Ellen emphasized the importance of accessing the SustiNet website, signing up for e-alerts, learning about other committees and task forces, seeing the calendar postings, and being able to view any materials cited in these meetings.  She said that the committee should create a list of groups and individuals that are of interest, locally and from other states, so that the committee can see what has already been done.  They could provide the committee with resources that hadn’t been considered previously.  An unidentified speaker recommended that the committee contact the Patient Centered Primary Care Collaborative.  He said that they have a lot of resources and that they have documented a number of pilot programs around the country and published their findings.  An unidentified speaker agreed, and said that there are forty pilot sites in medical home around the country, so it would be valuable to examine results and early findings from several of them.  Ellen Andrews said that perhaps the committee should contact the NCQA, which is accrediting medical homes, pointing out that standardization is needed for medical homes.  She also said that she was disappointed to learn that CT has no NCQA accredited medical homes, although some are in progress or considering applying.  An unidentified speaker said that he has a contact with someone who has implemented an NCQA certified medical home in two groups.  He said his contact gets very much into the nitty gritty of qualifications for NCQA standards, and he wanted to know if this committee wanted to get into that level of detail.  He also suggested that the committee try to get feedback from patients regarding medical homes.   Ellen said that she visited a medical home in Flushing, NY, and found that it provided a completely different way of practicing medicine than what she had experienced as a consumer.  She was told that it was a “patient centered model.”  What she found was a team, with everyone working at the top of their licensure.  They huddled the day before a patient’s visit, making sure that all ordered test results had been received, and that all services the patient needed were in place.  It was a well-coordinated effort that revolved around the patient.  She stated that she would like to see this happening in CT.

An unidentified speaker said he thought that this group should hear from someone who is knowledgeable about the financial performance of medical homes and medical practice, to ensure that they are sustainable.  He also pointed out that there is a lack of physicians who want to practice primary care.  An unidentified speaker said that she had recently read an article on the costs of implementing a medical home, and that she would like to ask one of the authors to participate in a conference call with this committee.  An unidentified speaker cited a recent NY Times article that described a crisis in recruiting medical students, physician assistants and nurse practitioners to enter the field of primary care.  He also said that he recently spoke with a former medical student of his who is participating in a patient-centered medical home, and that he had spoken about it positively.  An unidentified speaker said that in North Carolina there are outstanding examples of medical homes.  An unidentified speaker spoke about a group in Chicago that utilized chiropractic physicians in providing primary care, with excellent results.  They are Alternative Medicine Integration Inc., and he suggested that they be contacted for input into this effort.  Ken Lalime emphasized the importance of studying the financial aspect of this effort, saying that first it must prove to be sustainable.  He cited the Puget Sound System, and said that he had seen their data showing that it proved to be cost saving.  Vicki Veltri suggested that all information that committee members want to share could be sent to the Office of the Healthcare Advocate, where it will in turn be posted on the SustiNet website on this committee’s webpage.

An unidentified speaker said that there is an upcoming conference to be held on December 2, sponsored by the CT Center for Primary Care, called the Primary Care Summit.  There will be a number of leading national experts in medical homes, so it would provide valuable information for this committee.   Domenique Thornton said that it was important to her to be sure that mental health and primary care are integrated.  She agreed to share information that she has collected.  Jody Terranova said that the committee will need to consider communication, which is a vital part of holding the medical home together.  Ellen Andrews said that the drafters of the SustiNet bill have already considered this, creating a Health Information Technology Committee, and that Bruce Gould is our liaison to the board of directors, where information from all committees and task forces will be shared.  She pointed out that there will also be issues around primary care workforce, and that she is co-chair of that SustiNet group also.  She has approached that committee about doing a joint meeting with this one because there are a lot of overlapping issues.

Sheldon Toubman spoke of Primary Care Case Management, which is a medical home model in the Husky program, rolling out on January 1st in Greater Hartford and Greater New Haven.  He is working on trying to get primary care providers such as Pro Health to join in that endeavor.   He would like to invite a few of those providers to speak to the committee.   The committee will need to keep in mind that this is a non-insurance model so there is no HMO or insurance company.

Jim Cox-Chapman mentioned another group that might be helpful for this committee, called Transform Med, which is working with small practices, acting as practice consultants, helping practices adopt the principles of the patient-centered medical home.  An unidentified speaker said that it is not within the charge to the committee to choose any particular organization as the CT designee to provide medical home oversight or authority.   The committee can recommend that there be one or more options for providers, as this will be a radical change that may require assistance.  An unidentified speaker pointed out that employers want to be sure that they are paying for health and not just delivering healthcare.  It is very important for employers to determine how to share information without violating their employee’s health privacy, and to help design plans that support medical home.  An unidentified speaker said that there is a SustiNet Provider Advisory Committee that will be addressing this issue.

Ken said that the American College of Physicians has designed an inexpensive software tool called the Medical Home Builder.  Ken thought that it would be valuable to invite Michael Barr, the physician who created the software, to a committee meeting.  An unidentified speaker noted that there is also a website called the Medical Home Builder.  Ellen said that there have been several forums held to educate legislators about the medical home concept.  An unidentified speaker said that there will need to be an effort to educate primary care physicians about medical home, as the concept is still relatively unknown.

Ellen said that at the next meeting the committee will explore issue areas and groups, and begin to formulate a plan for how to proceed.

Meeting was adjourned.

Next meeting TBD