HomeWhat's NewA Conversation with...Joseph Mambu, MD

A Conversation with Joseph Mambu, MD

Family Medicine, Geriatrics and Wellness
Lower Gwynedd, Pennsylvania

We asked Joseph Mambu, MD — National Demonstration Project particpant and now a member of the Touchstone Group — a few questions about his practice's recent Level III NCQA recognition.

How did your experience in the National Demonstration Project support your practice in the NCQA PPC-PCMH™ recognition process?

We would have had a much more difficult time of it without the medical home components in place as a result of our TransforMED experience. This would have delayed our eventual certification costing us substantial amounts of money.

Why did you decide to pursue NCQA PPC-PCMH™ recognition for your practice?

As a participant in the SEPA Chronic Care Collaborative, we were financially incented to obtain our NCQA medical home certification. We were committed to pursue this recognition at the conclusion of the NDP, but SEPA accelerated the work. Our PPC-PCMH™ earned us approximately $57,000 for year one and $106,000 in both years two and three of the collaborative.

Tell us in general about your experience in gaining NCQA PPC-PCMH™ recognition.

It was a team effort spear-headed primarily by Jessica Schmitt, our practice administrator who wrote her master's thesis about the process. Our EMR/PMS and Phytel business partners assisted us via several conference calls. We also capitalized on the patient metrics generated by our exercises with Transformed. Having multiple conversations with NCQA proved valuable. What was especially helpful was their handout categorizing and then recommending the electronic format of the documentation required by each element. This I'm sure facilitated the processing of our application by NCQA.

Your practice recently received recognition as an NCQA PPC-PCMH™ Level III. Describe your perception of how this affects the staff and patient's experience of the practice as a true "medical home"?

First of all it was an accomplishment and source of pride in which the entire office shared. The recognition spread then to the surrounding medical community and news media – all of which bolstered this sense of pride in what we accomplished. It certainly facilitated my efforts to organize and communicate the importance of what we were all doing in trying to perfect the medical home concept. As for the patients, few if any grasped the significance of what we achieved. They just know and appreciate being able to get in to see a doctor when they want, the kind and efficient treatment they receive and their sense that they are being care for by a progressive medical team truly concerned with their overall well being.

In your experience, what was the hardest aspect of the recognition to achieve?

The referral and test tracking requirement necessitated an EMR upgrade to accomplish that. I think Jess would tell you that the hardest aspect was the accumulation and submission of the documentation after trying to figure out what they wanted — and was it enough. For most practices that don't have the benefit of TransforMED, getting the team together and implementing the various components of the medical home model will prove the most challenging.

What was the easiest aspect of recognition for your practice?

Having Jess do all the hard work.

Do you have any insights or words of wisdom for practices considering beginning the process for NCQA PPC-PCMH™ recognition?

Yes – Just do it. Think of it as an investment of both time and money to transform a practice from the harried volume-based model to one that can document value in their clinical performance.

Payment reform is coming; it must.

Since the transformative process to a medical home will take on average several years, start now. Learn what is required to become a medical home and what is required by NCQA. Start building teams, enhance communications, recognize what leadership there is and improve upon it if necessary. Explore electronic records and disease management. Familiarize the doctors and staff about the latest chronic disease management models.

We, as primary care physicians, have to be ready when employers, governments (both locally and nationally) and patients want healthcare from medical teams working out of medical homes. Medical home networks will form that could further enhance how patients are cared for and how they pay for their care. These networks will require NCQA certification. Waiting until all this is in place may be too late.

Visit their Web site: Family Medicine, Geriatrics and Wellness - Lower Gwynedd, Pennsylvania