The PCPCH Program recently conducted a site visit with a PCPCH that went the extra mile to improve access to primary care within its wider community. JD Health and Wellness in Salem shared their journey with us of how they came to provide high-quality, compassionate, accessible, integrated primary care and behavioral health services in both the traditional office setting and at multiple local community-based settings in need of access. |
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“During the Covid-19 pandemic our entire way of functioning as a society and community shifted in a way never experienced before.” But for JD Health and Wellness, it also came with the opportunity to provide support for their neighbors at the Union Gospel Mission men’s shelter in Salem, including pre-entry rapid covid testing that allowed the unhoused men in the area to gain entry and shelter just before the cold rainy season in the Fall of 2020. JD Health & Wellness also provided brief screenings for physical and behavioral health and offered further services as needed.
Word of their success in offering accessible, same-day, on-location primary care and behavioral health services spread throughout the community, and JD Health and Wellness ended up being approached by several of the other local shelters and transitional housing agencies hoping to work together. In response, JD Health and Wellness decided to both continue services at their main Lancaster Drive location, and provide them at additional community locations including the Union Gospel Mission men’s shelter, the Simonka women’s and children’s shelter, Arches Inn temporary and medical recovery housing, Church at the Park Village of Hope and Catholic Community Services, as well as the Navigation Center and the PAC Community Center for youth.
JD Health and Wellness now works to provide in-person, telemedicine, and telephone visit options and has expanded their services to include primary care, behavioral health, medication-assisted treatment for opiate use disorder, peer support and community health workers, social supports, BHI, and remote patient monitoring. They operate with the belief “that all people deserve health care and the most effective health care is integrated to include both physical and behavioral health.” Their onsite collaboration with local community partners—coordinated between all of their departments— is making a difference in the lives of those in their community impacted by the homeless crisis.
“It is a privilege to be accepted into this community and be able to bring our compassionate care to all we can reach.” - Anna Boyd, N.D.
Fridays, noon - 1pm
Beginning in January of 2025, all practices applying or re-applying for PCPCH recognition will need to do so under the 2025 PCPCH Recognition Criteria. Program staff are hosting a webinar series to help practices understand some of the revisions and additions under the new model. This is a great opportunity to familiarize yourself with the new model and ask questions about specific standards! See upcoming sessions below and click here to see the full webinar schedule and register for more sessions!
Standard 2.A – Performance and Clinical Quality (May 24, noon-1pm)
 Many PCPCHs partner with CCOs and other agencies on quality metric goals and specifications, which can change over time. In this session, PCPCH Program staff will review some of the overall revisions to Standard 2.A under the 2025 model such as a more flexible menu of quality metrics for practices to choose from, intended to make it easier to align with other partners. We'll also review the addition of two new measures related to tracking and reducing disparities in quality measure performance, as part of OHA's commitment to supporting a primary care delivery system that meets the needs of those experiencing health inequities and barriers to utilizing primary care services. Click here to register.
Standard 2.E – Ambulatory Care Sensitive Conditions Utilization (June 7, noon-1pm)
 In this session, PCPCH Program staff will review some of the overall revisions to Standard 2.E under the 2025 model such as a more flexible menu of utilization metrics for practices to choose from, the removal of value-based payments (which is being parsed out into its own standard), and a shift in focus in Measure 2.E.3 from meeting specific utilization measure performance outcomes to following up with patients experiencing disparities in utilization measure performance, as part of OHA's commitment to supporting a primary care delivery system that meets the needs of those experiencing health inequities and barriers to utilizing primary care services. Click here to register.
Standard 3.D – Health Related Social Needs (June 21, noon-1pm)
 Beginning in 2023, CCOs have been required to screen members for housing insecurity, food insecurity, and transportation insecurity and partner with community-based organizations to provide interventions for these three HRSN. In this session, PCPCH Program staff will review some of the overall revisions to Standard 3.D under the 2025 model such as a new requirement that practices be screening for at least three HRSNs, more flexibility on how patients can be screened, additional guidance around trauma-informed screening, and the inclusion of closed-loop referrals as one of the activities that can meet 3.D.3. We'll also review some of the structural changes to the standard including the consolidation of measures, the change to check-all-that-apply, and the increase in total points available. Click here to register.
PCPCH Standard 6.B encourages primary care practices to connect their patients with opportunities for self-management of their conditions and overall health. OHA’s Health Promotion and Chronic Disease Prevention division is partnering with the Oregon Wellness Network, who has just launched a new self-management class portal and service that can receive referrals and help patients enroll for many self-management programs across the state, including:
- Chronic Disease Self-Management Program
- Diabetes Self-Management Program
- Diabetes Prevention Program
- Tai Chi-Quan: Moving for Better Balance
- Walk With Ease
Visit the link above if your office would like to refer patients to one or more of these programs or to find out more information about the different programs available across the state! Questions can be sent directly to the Oregon Wellness Network at health.promotion@nwsds.org or to Lizzie.E.Moore@oha.oregon.gov.
In honor of Arthritis Awareness Month, below are a couple opportunities to improve care for patients with arthritis!
Free 0.25 CME opportunity for clinicians: Expand your knowledge about non-pharmacologic interventions for patients with arthritis or at risk for arthritis
Promote patient well-being and expand your knowledge on arthritis appropriate evidence-based interventions and Lifestyle Management programs for arthritis. Designed for primary care physicians, nurse practitioners, physicians assistance, and others, this course will help you self-assess your learning needs related to non-pharmacologic interventions for patients with arthritis or at risk for arthritis and to explore ways to incorporate arthritis appropriate evidence-based interventions into your patients’ treatment plans. Click here to learn more and begin the course.
Free Walking Program to Help Patients Manage Arthritis and Other Chronic Conditions
For patients with arthritis, Walk With Ease offers an online, self-directed six-week walking program that is free to all Oregonians and does not require an official referral! Walk With Ease is proven to reduce the pain and discomfort of arthritis, increase balance, strength and walking pace, build confidence in the ability to be physically active, and improve overall health. In addition, regular walking is associated with lower risk of cardiovascular disease and improvements in mood, cognition, memory, and sleep.
Questions?
We are here to help! Contact us at PCPCH@oha.oregon.gov
About the Patient-Centered Primary Care Home Program
Patient-Centered Primary Care Homes (PCPCHs) are health care practices that have been recognized by the Oregon Health Authority (OHA) for their commitment to providing high quality, patient-centered care.The PCPCH Program administers the application, recognition, and verification process for practices applying to become Patient-Centered Primary Care Homes.The program is also working with partners across Oregon to support adoption of the primary care home model. For more information visit www.PrimaryCareHome.oregon.gov.
The mission of the PCPCH Program is to be a trusted partner in primary care, collaborating with stakeholders to set the standard for transformative, whole-person, and evidence-based care.
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