Kansas Patient Centered Medical Home Initiative: The Patient, The Person at the Center of my Care

Kansas Patient Centered Medical Home Initiative: The Patient, The Person at the Center of my Care.


What happens when a health care provider is helped by a patient?

When I realized that the best way to explain patient-centered care was to start asking for patients to share their stories, I found out quickly that providers had exceptional stories to share as well.  And, I would be remiss if I didn’t embrace all perspectives of patient-centered care.

If we are fortunate (and the good news is shared), we have many opportunities in our lifetimes to hear of individuals that have been helped by their health care providers.  We learn of life-saving diagnosis and intervention.  Or we are moved by inspirational stories of life-changing, and often life-saving, behavioral change.  But how often do we hear of the equally uplifting stories of patients helping providers?  I say, “not enough.”

So, with this in mind, I am very blessed to share Maria’s story.  Maria was Richard’s favorite nurse. Richard was my nephew’s favorite uncle.

In her own words…Maria, and Richard’s, Story…

In October, I will be running the Chicago marathon.  I’m not a runner, but was inspired by my friend, Richard, to join the SCIS (Spinal Cord Injury Sucks) team and commit to raise money for spinal cord injury cure research, as well as awareness of the devastation that spinal cord injuries can cause.

Richard will not be there, at the finish line, to celebrate my run.

Unfortunately, I am running not only in honor of Richard, but in memory of him, as Richard passed from complications of quadriplegia last February.

I was part of the care team that got to know Richard during the months he spent at OU Medical center following a spinal cord injury that left him paralyzed from the chest down. I was able hear about the things he loved before his injury, how he lived an active and full life while teaching others to do the same.  He created a personal workout regimen for me and cheered me on in a weight loss competition (one that I lost by 0.5 pounds,grr).  I came to love the person he was and had become after his injury.  I am a better person for knowing him and am trying to “pay it forward” by raising money for spinal cord injury research.

They [spinal cord injuries] are, unfortunately, a very common injury and devastate the person and the family. Read about the organization I am running for, and its founder, who has sustained a spinal cord injury himself.

Please, donate to this cause and help spread awareness about spinal cord injuries. You can make a difference! Thank you!


Health 3.0 … Piecing the puzzle back together

As many of you that were able to attend our first Health 3.0 Networking event observed, we had a very diverse group of health care providers that function in multiple health care roles at our event.  We had pharmacists, physicians, surgeons, educators, periodontists, optometrists, heart specialists, and more.  We had CFOs, CEOs, COOs, Practice Managers, directors, providers, and health care consumers.  The list goes on.


Yet even with this diverse group of attendees, every discussion I encountered shared one common unifying question…How do I fit into PCMH? 


And, of course, the short answer to that question was, and still is…”We are still all trying to figure it out.”


And, as part of the process, we can start by thinking of it this way…We’re trying to piece back together a puzzle that should have never become as disassembled and disconnected as it has over the past several years. After all, the puzzle shares the same unifying glue –patient health – at the very center.  So, how can we effectively throw a piece here or toss a piece there (or forget where we placed a piece) and expect to reassemble it on command?


It’s tough.  But just like any master puzzle assembler (is there such a word?) would tell you, you have visualize the finished piece, the end result, before you can start taking the most efficient steps toward assembly.  You have to know where the blues go and the reds belong in order to find the corner pieces and build the framework.


So, how do we get the big picture and snap the pieces back into place?  First we have to agree to what the finished piece is.  Is it *health* as an outcome that we want to achieve?  Is it accreditation so we can (hopefully) improve our margins?


Maybe we start re-connecting on various levels…We connect by re-organizing around patients at our respective organizations or the organizations we support.  We then communicate what we’re doing, what we need, what we’ve learned and start learning about other organizations outside our own. And, even if we haven’t started re-organizing internally, we utilize networking to reach beyond who we currently know – not unlike the goal of the Health 3.0 Event – to create living, breathing learning organizations greater than ourselves.


With this process in mind, an incredible health care provider that I have been fortunate enough to find through networking (@DocForeman), has shared a proposed rule for Medicare programs that speaks directly to behavioral health’s role in PCMH and the importance, nay requirement, of an interdisciplinary approach.


Even for those of you that weren’t able to attend our Health 3.0 event, I can share that the PCMH model is rapidly gaining momentum in our health care industry.  The pieces are coming together.  And, like any change, the question is do you want to be part of creating the puzzle?  Or forgoing your choice and merely receiving your assigned piece once the framework has been built?


You decide.



Medicare Program; Conditions of Participation (CoPs) for Community Mental Health Centers

A Proposed Rule by the Centers for Medicare & Medicaid Services on 06/17/2011


This proposed rule would establish, for the first time, conditions of participation (CoPs) that community mental health centers (CMHCs) would have to meet in order to participate in the Medicare program. These proposed CoPs would focus on the care provided to the client, establish requirements for staff and provider operations, and encourage clients to participate in their care plan and treatment. The new CoPs would enable CMS to survey CMHCs for compliance with health and safety requirements.


In proposed § 485.916(a), “Standard: Delivery of services,” we are proposing that the CMHC designate a physician-led interdisciplinary team for each client, which would include either a psychiatric registered nurse, clinical psychologist, or clinical social worker, who would be a coordinator responsible, with the client, for directing, coordinating and managing the care and services provided to the client. The team would be composed of individuals who would work together to meet the physical, medical, psychosocial, emotional, and therapeutic needs of CMHC clients.


The interdisciplinary team would include, but would not be limited to the following:

  • A doctor of medicine, osteopathy or psychiatry.
  • A psychiatric registered nurse.
  • A clinical social worker.
  • A clinical psychologist.
  • An occupational therapist.
  • Other licensed mental health professionals, as necessary.

Spotlight on Kansas PCMHI Journey: Meet Debbie Pennington

When I took this position in January of this year, I was concerned that I would have many roadblocks when attempting to assemble a fantastic team that can support each other in the effective delivery of patient-centered care.  And, while there have been a few bumps in the road, a few battles to wage, and hills to climb, the journey has already been rewarding.

So, for the next few weeks I’m going to share some profiles of people that have committed to joining me on this journey.  I am in awe of their dedication to the patients and communities they serve.  I am equally in awe of their willingness to go the extra mile to take on the difficult challenge of health delivery transformation.

So, if you will, please join me as I repeat that famous SNL chant from Wayne and Garth “We’re not worthy!  We’re not worthy!” and appreciate those that lead the way…

Meet Debbie Pennington

Debbie Pennington RN, BSN, Neonatal Medical Home Coordinator-Nurse Navigator with the Department of Pediatrics-Division of Neonatology at University of Kansas Physicians.

Try saying that fast 3 times.

And in reality, if you’re really looking at her credentials, you would also add…Patient Centered Medical Home Champion, Super Woman, and fantastic human being.

Now, try to cram all of that on one business card.

You can’t.  But Debbie can.  And she can manage all of these responsibilities and proficiently perform all of these roles every day.

I’ve been fortunate to recently meet and work with Debbie and Dr. Prahbu Parimi, MD, Professor of Pediatrics, Chief, Division of Pediatric Neonatology with KU Pediatrics at the University of Kansas Medical Center as they have both taken on yet another role as participants in the Kansas PCMHI Health 3.0 Program.  I am excited, and yes in awe, that I have the opportunity to work with them and their teams over the next 2 years.  My hope is that I’ll get to keep them on my personal list of business associates for life – far after our grant has run its course.

Now Debbie, not being one to slack, will also be sharing the story of patient-centered care at the National Perinatal Association (NPA) 2011 conference: Winning the Race in Providing Quality Perinatal Care – Practicing Good Nutrition and Prevention of Infection from October 20-22, 2011 in Louisville, KY.  She’ll be presenting the Neonatal Medical Home as a plenary session on Saturday, October 22, from 8:00 a.m. – 9:00 a.m.

We are so thrilled that she and her team are part of our broader Kansas PCMHI team.

As some of you know, the Kansas Chapter of the American Academy of Pediatrics is a founding member of our KPCMHI Coalition aka they got the ball rolling toward PCMH in Kansas.  So, it’s thrilling to witness first-hand the transformation in pediatrics to a higher level of patient-centered care at the KU Neonatal Medical Home.  And to be in “awe” of the people that make it happen.

Thanks Debbie!

Changing the world … one thoughtful, committed citizen at a time

What did I share in my last post? “Never doubt that a small group of thoughtful, committed citizens can change the world. Indeed, it is the only thing that ever has.” (Margaret Mead)

Well I’m pleased to share that a few more thoughtful, committed citizens have decided to support the Kansas PCMH Initiative.

Wednesday, April 20, 2011, Blue Cross and Blue Shield of Kansas and the Kansas Academy of Family Physicians announced that the state’s largest health insurer is supporting the Kansas Patient-Centered Medical Home Initiative by providing financial assistance to pilot participants.

Blue Cross will donate $20,000 to the grant fund in order to cover the $2,500 per practice fee that pilot participants are required to pay. In addition, Blue Cross is developing modified reimbursement options for the eight participating provider practices that will include both fee-for-service payments and incentives to support successful transformation to a PCMH model.

“Blue Cross is committed to exploring the patient-centered medical home model as we believe this model of care could well be the wave of the future for primary care,” said Michael D. Atwood, M.D., chief medical officer for BCBSKS and former family physician. “If this pilot proves successful, it may provide a model for possible expansion to a wider group of primary care physicians in the near future.

“We have been discussing the role of a payer in this pilot with KAFP leaders for some time, and are pleased that we have identified a meaningful way for us to collaborate with the coalition. By agreeing to cover the physician financial component we are hoping to reduce that barrier and encourage additional applications,” Dr. Atwood said.

“We are thrilled that Blue Cross and Blue Shield of Kansas supports this important health initiative in our great state,” said Carolyn Gaughan, CAE, executive director, Kansas Academy of Family Physicians.

Applications to participate in the pilot are due April 30. Visit http://kansaspcmh.org/kspcmh for the application and instructions on how to apply.

As a reminder, we must credit the few thoughtful citizens that collectively started the ball rolling in Kansas – the KAOM, KAAP, KACP, KMS, and KAFP. Add to these thoughtful citizens the committed citizens of the Kansas Health Foundation, Sunflower Foundation, and United Methodist Health Ministries who believed enough to provide this initiative with a strong financial base, and maybe, just maybe, together we can truly change the world.

Funding for Kansas PCMH Initiative was provided in part by the United Methodist Health Ministry Fund, a philanthropy based in Hutchinson, Kansas; Sunflower Foundation: Health Care for Kansans, a Topeka-based philanthropic organization with the mission to serve as a catalyst for improving the health of Kansans; and the Kansas Health Foundation, a private philanthropy dedicated to improving the health of all Kansans. For more information about these organizations visit: www.healthfund.org; www.sunflowerfoundation.org; and www.kansashealth.org.

Margaret Mead, Rush, and The Other Guys

Never doubt that a small group of thoughtful, committed citizens can change the world. Indeed, it is the only thing that ever has. Margaret Mead US anthropologist (1901 – 1978)

It’s been awhile since I’ve heard these words of encouragement.  It was refreshing to hear Cyndy Nayer, President and CEO for the Center of Health Value Innovation share these assurances at the Wichita Business Coalition on Health Care meeting this past week.

When pondering change on a global level, I believe that many of us often find ourselves caught somewhere between how much influence we can have on a grand scale and what is completely beyond our scope of influence.  It’s the completely beyond part that seems to paralyze us from the start. 

We have not only lost faith in the system, but more importantly we have lost faith in each other.  Without that faith it’s hard for many of us to find the courage necessary to take the first step forward.  We assume that if we do, even those that believe as we do will keep quiet, stay at the back of the line, and keep their heads down.

Don’t get me wrong. I am not saying that everyone is without this faith.  There are several that still believe.  They are scattered among us.  I am one of the scattered.  But I too often feel trapped in that “Can I really make a difference?” mental argument. 

But I’m not a fan of paralysis.  And, I’m definitely not a fan of doing nothing.  One of my favorite bands, Rush, pointed this out in their powerful song, Free Will: “Even if you choose not to decide you still have made a choice.” I choose free will. Not how do I find, as Margaret Mead so eloquently stated, that “small group of thoughtful, committed citizens” that can indeed impact change for the better?

This is why I have taken the post as the Kansas Coordinator for the Patient Centered Medial Home Initiative.  Not, because I’m excited about the acronyms, or the title, but because in this role, my goal is to find those committed individuals.  I am hoping you as a reader of this blog are one of the committed. 

Health care is a great example of an important dimension of all of our lives that feels so completely beyond our control.  I’m not in this to be the hero or the savior of health care, I am in it to influence health care for the better and find others like me that want to do the same.

I’ll close with a short dialogue between Terry (Mark Wahlberg) and Allen (Will Ferrell) from The Other Guys

Terry: …the city is dying for a hero.

Allen: Really?

Terry: Yeah

Allen: What about 9 million socially conscious and unified citizens all just stepping up and doing their part?

What do you think?

It’s about… definitions and acronyms and stories

We’re all about definitions in the business world, aren’t we?  Long hairy ones with lots and lots of syllables.  And acronyms.  Hmmm. Who doesn’t love a good acronym? 

I’ve decided that since entering into the realm of the medical world just 4 short weeks ago that acronyms rule in the world of medicine, and whomever has the most acronyms wins.  What do they win?  I’m not really sure.

But what I am sure of is that we need to understand that when communicating our various messages to the various audiences with whom we desire to understand what it is that we really do, we need to move beyond what looks great on a wall plaque or a mission statement that no one in the office can remember.  (So, how was that sentence for a mouthful?  It could be a mission statement.) In real speak, we need to develop meaningful messages that can be shared orally in the form of a short story (We all like good stories, don’t we?) or can be written on something as small as a cocktail napkin.

So, why am I sharing this with you?

As I shared earlier in this post, I was hired 28 days ago to coordinate the Kansas Patient Centered Medical Home Initiative.  As the name implies, it’s centered in health care.  My charge was, and still is, to not only coordinate the various aspects of this audacious task, but to find a way to craft messages about the initiative that anyone can understand.  The PCMH (Remember, it’s health care, and health care loves acronyms.) business model is just that, a model.  It’s a concept.  So, it’s difficult to visualize, even more difficult to understand.

And, there are a variety of stakeholders (fancy business speak) that are impacted by this new model of health care, each of which have their own level of knowledge and their own personal agenda. So, how am I to craft a meaningful message or set of messages for all of these people that makes sense?  My solution?  I’ll ask the stakeholders.

So, stakeholders, because guess what, each and every one of us that are living and breathing are stakeholders in health care, what does the following mean to you?

The definition of a medical home according to Kansas law (K.S.A. 75-7429) is: “A health care delivery model in which a patient establishes an ongoing relationship with a physician or other personal care provider in a physician-directed team, to provide comprehensive, accessible and continuous evidence-based primary and preventive care, and to coordinate the patient’s health care needs across the health care system in order to improve quality and health outcomes in a cost-effective manner.”

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