March 24, 2014, marked the start of an amazing journey of transforming Dillon Internal Medicine into a Patient-Centered Medical Home.  Jennifer Sammons, the project manager, said, “she was honored and nervous to lead the huge project along with Physician Champion, Dr Phi Wallace, and Clinical Manager, Robyn Berry, LPN.”
The project began with the staff visiting a Patient Center Medical Home practice that had already undertaken the transformation processes and was a Level 3 NCQA recognized practice.  They brought back ideas and recommendations the practice had experienced on their journey and matched those with the guidelines set by NCQA and their current policies.
They held weekly team meetings with providers and the supervisors from the various departments of our practice. The team leaders took back to their staff the policies as they were developed.  Joanie Price, Office Manager, said, “our staff is to be commended for accepting multiple changes in job descriptions and duties during the workflow enhancements”.
There were new roles added such as a Case Manager and Care Coordinators who work one-on-one with their patients to improve continuity of care.  The Case Manger closely follows their high risk patient population and transition of care from emergency room visits and inpatient hospital stays.  In addition she conducts daily huddles with each provider and his or her direct team members.   Their Care Coordinators schedule and track all procedures and referrals to outpatient facilities and specialist.
They added a self check-in kiosk and phone tree system to improve access and communication for our patients.  They formed a quality improvement team that continually identify patients within a risk group, conduct patient outreach, and improve quality of care by educating and treating the patient. Robyn Berry, LPN said, “our number one goal is patient satisfaction.  Our staff and providers became a stronger healthcare team through the process”.
One of their quality measures is colon cancer screening. As a result of identifying patients in the risk group, and reaching out to them through an automated message in our phone tree one patient in particular responded by calling our office to schedule his screening colonoscopy.  
During the screening procedure, Dr. Wallace identified potential cancerous polyps which were biopsied.  
Dr Wallace said,  “the patient has had the polyps identified and removed, and the patient has possibly eliminated colon cancer as a diagnosis.  This is one of the opportunities a patient has to be proactive in his or her care and have a healthier outcome as the result.  The model is a different way of reaching our current and future patient population”.
Prior to starting their PCMH journey we were providing test tracking, patient self-management, electronic prescribing, and using a certified electronic health record, but the PCMH model has helped then organize and improve patient care and have better outcomes for their patients.
They appreciate the patience of our patients during the transition. They also appreciate the support of Blue Cross Blue Shield during the transformation.
They are proud to say our dedication to the goal of achieving the highest recognized Level 3 PCMH took many hours, and it is now a reality for their practice.

WASHINGTON, DC—The National Committee for Quality Assurance (NCQA) today announced that Dillon Internal Medicine Associates, PA of Dillon, SC has received NCQA Patient-Centered Medical Home (PCMH) Recognition for using evidence-based, patient-centered processes that focus on highly coordinated care and long-term, participative relationships.
The NCQA Patient-Centered Medical Home is a model of primary care that combines teamwork and information technology to improve care, improve patients’ experience of care and reduce costs. Medical homes foster ongoing partnerships between patients and their personal clinicians, instead of approaching care as the sum of episodic office visits. Each patient’s care is overseen by clinician-led care teams that coordinate treatment across the health care system. Research shows that medical homes can lead to higher quality and lower costs, and can improve patient and provider reported experiences of care.
“NCQA Patient-Centered Medical Home Recognition raises the bar in defining high-quality care by emphasizing access, health information technology and coordinated care focused on patients,” said NCQA President Margaret E. O’Kane.
“Recognition shows that Dillon Internal Medicine Associates, PA has the tools, systems and resources to provide its patients with the right care, at the right time.”
To earn recognition, which is valid for three years, Dillon Internal Medicine Associates, PA demonstrated the ability to meet the program’s key elements, embodying characteristics of the medical home. NCQA standards aligned with the joint principles of the Patient-Centered Medical Home established with the American College of Physicians, the American Academy of Family Physicians, the American Academy of Pediatrics and the American Osteopathic Association.
To find clinicians and their practices with NCQA PCMH Recognition, visit http://recognition.ncqa.org.

About NCQA
NCQA is a private, non-profit organization dedicated to improving health care quality. NCQA accredits and certifies a wide range of health care organizations. It also recognizes clinicians and practices in key areas of performance. NCQA’s Healthcare Effectiveness Data and Information Set (HEDIS®) is the most widely used performance measurement tool in health care. NCQA’s Web site (ncqa.org) contains information to help consumers, employers and others make more informed health care choices.