Two Volumes

This notebook in two parts, Book A and Book B, is a living document. The process it details is ongoing and will be continuous for as long as Southeast Texas Medical Associates, LLP exists. The only thing that is absolutely certain is that the future will not look like the present and that we believe that it should not. What is uncertain are the structure and direction of healthcare over the next fifty years. Yet, with these certainties and uncertainties, we believe that the principles, intents and goals of "health home" are the future of medicine and that we want to be a part of that future.

SETMA's pilgrimage to Patient-Centered Medical Home - soon to be called "Health Home" by everyone - is detailed in the history which follows. The process is detailed in the following sections in this introduction. It is our hope that this historical record, which is a "snapshot" of an ongoing process, will remind us of where we have come from and of where we are going.

Book A

SETMA's History with Patient-Centered Medical Home Project

From attending MGMA in 1997 to adopting NextGen EMR in 1998, to electronic patient management, to patient-centered medical home, in retrospect SETMA's journey has been a continuum toward a goal not seen from the beginning. This brief history discusses some of the highlights of our pilgrimage which is only now just beginning.

SETMA's Growing Understanding of PC-MH 02/19/09 to 0604/09

This is a series of articles which SETMA prepared while we learned about PC-MH. They effectively show our growth and understanding of the process. It cannot be overstated that we do not believe that we have "arrived," but we are confident that we are "on the journey." We believe we direction and the vision we have is right and that both are elastic and expansive enough to allow us to absorb and to be absorbed by the best of the future of healthcare.

SETMA's Analysis of Practice by CMS 28 Requirements 02/16/09 to 03/14/09

This was the beginning. After the fateful February 16th meeting about PC-MH in Houston, SETMA's partners and executive management undertook at thorough analysis of our practice based on the 28 CMS Requirements for a PC-MH. The document present here is without the Appendices; the original document was almost 400-pages long. This part of our journey took almost a month. At its conclusion, we were confident that SETMA fulfilled all 28 requirements and we were equally confident that we were not a PC-MH.

NCQA's 9 Standards, 30 Elements and 183 Data Points

After our CMS analysis, we discovered that CMS did not have and was not likely to have an accreditation process for PC-MH, but that the National Committee for Quality Assurance did. This document is our analysis of the NCQA requirements for recognition as a PC-MH. This document would form the foundation for our work over the next twelve months. When my principle collaborators Major (US Army Retired) W Bryan Sims, SETMA CMO and CFNP and Jonathan Owens, SETMA Chief Software Development Engineer, attended the NCQA training meeting in Washington, D, C., in July, 2009, we had virtually memorized this material. When we attended the Medical Home Summit in Philadelphia in the fall, 2009, we realized that we were very close to being ready to apply for recognition. We also learned that there is another accrediting agency Accreditation Association for Ambulatory Health Care (AAAHC0. Once we complete the NCQA process, we will apply for certification by the AAAHC as well.

NCQA Preliminary Score

SETMA is applying for PC-MH recognition as three clinics - SETMA I (Calder), SETMA II (College) and Mark A. Wilson SETMA West (Dowlen). When the NCQA Survey Instrument was completed, the NCQA website "scored" the application. This is the result of that scoring. We are aware that it is unlikely that the survey will result in this high a score but we are hopeful that it will result in a Tier-III recognition. Whatever our score and whatever our designation, we will publish both.

NCCQA Completed Application

This document is produced on the NCQA website once all of the Standards, Elements and Data Points have been noted and the supporting documents have been attached. It is SETMA's estimate of whether we comply or not with each of NCQA's 9 Standards 30 Elements and 183 Data Points.

NCQA Application Notes and Comments

These are the note and comments attached within the NCQA application. Within the application, opportunity is given to add "notes or comments" to any or all of the data points in the 9 Standards and 30 elements.

Where To From Here

This is a brief explanation of SETMA's progress toward Public Reporting of our providers' performances on quality metrics and of what we expect the immediate future of SETMA to look like as we continue to transform our practice and as a result continue to transform our delivery of healthcare.

Book B

NCQA Document Library NCQA Summary

This is the NCQA application summary of the standards, elements and data points with the name of each of the documents attached in support of those documents

NCQA Document Library

This section contains all 68 of the documents which are part of SETMA's application and which are attached to the application.