The Blueprint

The Blueprint blog is the main channel that we use to let Medical Home Project participants know about upcoming events, new tools, and research.

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We invite you to send us links, information, dilemmas or lessons learned that you think your peers in the project might like to see on this blog. Email me at with anything you would like to see included.

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Amanda Berra

PA/NP role in ACO? Look to the PCMH

Amanda Berra May 26, 2011

Today we received the question, "What information do you have on the potential use of PAs in the ACO model?"

From a sheer regulatory perspective, regarding ACOs in current Medicare pilots, PAs are not included in the set of primary care providers to whom patients may attributed under the Shared Savings Program (SSP). However, under the new Pioneer ACO Model, patients can align with PAs (that is, PAs are included in the definition of PCPs.)

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Comparing PCMH recognition options

Amanda Berra May 25, 2011

Our data shows that 39% of self-identified medical homes are formally recognized by an organization, most frequently NCQA. But options for recognition are multiplying-- causing Medical Home Project participants to ask how to make an informed decision about which one to pursue (if any).

One great new resource: A new white paper by the Urban Institute profiles and, more importantly, compares, 10 different PCMH recognition approaches on the basis of content domains, what their scoring systems tend to emphasize, and what could be called feasibility: Cost, time to complete, endorsements, etc.

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New Shared Savings Rule: PCMH Implications

Amanda Berra April 8, 2011

The proposed rule for the Medicare Shared Savings Program provides an initial roadmap for how providers could be reimbursed by Medicare as accountable care organizations (ACOs). Reading the rule from a medical home perspective, we see strong reinforcement of the importance of the medical home model in achieving shared savings goals. The rule also points the way toward future direction of PCMH model evolution--for example, by updating and expanding the CMS definition of "patient-centeredness" and laying out some objectives that even the most advanced PCMHs will have to stretch to meet.

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Risk-Stratifying Patients - Two Example Approaches

Amanda Berra April 4, 2011

Why Risk-Stratifying is Important

Ability to risk-stratify patients is one of the major differences between beginning and advanced PCMHs. While beginning PCMHs have their hands full just establishing a patient/disease registry, identifying patients with target conditions, and flagging gaps in care, the more advanced PCMHs are able to sort patients into high, moderate, and low-risk categories. (Note -- for all practical purposes, "risk" here means "risk of hospital admission").

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Elevating Staff to Top of License at Kaiser Permanente NW

Amanda Berra March 21, 2011

The fact that medical homes must find ways to raise clinical staff to "top of license" has become received wisdom in the medical home community. What hasn't been as extensively addressed is exactly how.


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Three Main Options for Incorporating Mid-level Providers into Primary Care Practices

Amanda Berra March 9, 2011

A crucial starting point for enabling overburdened PCPs to move toward enhanced primary care delivery is to leverage mid-level providers (nurse practitioners and physician assistants) to bolster PCP productivity and patient access.


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Joint Commission Taking Feedback Now on Proposed Primary Care Home Designation

Amanda Berra March 8, 2011

The Joint Commission draft standards are up for a Primary Care Home (PCH) designation as an optional add-on to its existing Ambulatory Care Accreditation Program, and the industry has a chance now to give feedback. Feedback must be received by March 14, 2011.


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PCMH Staff Data: Benchmarks Suggest Transformation in Staff Model, Site Functions

Amanda Berra March 7, 2011

Early findings from our primary care/medical home benchmarking initiative provide a quantitative snapshot of medical homes investing in more clinical support staff per physician and taking on new site-level functions.


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