Download to read offline
Uploaded byPaul Grundy
Stfm april 28 2011
This document discusses the patient-centered medical home (PCMH) model and its benefits. It provides 3 key points: 1) The PCMH model emphasizes primary care-led, coordinated, and comprehensive care centered around the patient. It aims to improve access, outcomes and reduce costs through care coordination and an emphasis on prevention. 2) Studies show PCMH interventions can reduce hospital and ER use by over 30% each and lower total costs by 9% while maintaining or improving outcomes. 3) Successful PCMH models require health IT and data sharing to facilitate care coordination, population health management, and quality improvement. They also rely on payment reforms that appropriately recognize the added value of the medical
More Related Content
![Va pcmh study 6 2014[1]](https://cdn.slidesharecdn.com/ss_thumbnails/vapcmhstudy620141-140801153322-phpapp02-thumbnail.jpg?width=640&height=640&fit=bounds)
Stfm april 28 2011
- 1. PCMH STFM 2011PaulGrundy, MD, MPH, FACOEM, FACPM IBM Director Healthcare TransformationPresident Patient Centered Primary Care CollaborativePaul Grundy MD, MPH IBM International Director Healthcare TransformationTrip to Denmark July 10 2009
- 2. Who was theShooter’s Doctor? Population managementAccountability
- 3.
- 4. Why Innovate Affordability$30,000+166%$25,000$20,000$15,000+118%$10,000$4,918$5,000$0200120092019 - Employee Payroll Contributions- Employer Cost- Employee Out of Pocket ExpensesaThe Elephant in the room$28,530Costs continue their upward climb……with employers still picking up much of the tab…$10,743
- 5. The Cause? Mostlydue to unregulated fee-for-service payments and an over reliance on rescue/specialty care. This is stark evidence that the U.S. health care Industry has been failing us for years “Commonly cited causes for the nation's poor performance are not to blame - it is the failure of the deliver system!!”You the AHC’s - Unaccountable Care Organizations PART of this problem * Peter A. Muennig and Sherry A. Glied Health Affairs Oct. 7, 2010
- 6. Health care isa business issue, not a benefits issue
- 7. 3° Care2° CareWhat’swrong with this picture?1° CareEvery country starts at the base of the pyramid with primary care, and they work their way up until the money runs out.… “We start at the top of the pyramid, and we work our way down until the money runs out…And so we have to change the pyramid. We have to start at the base.”3° Care2° Care1° Care
- 8. Don’t handle yourcare needs in a BAD MEDICAL NEIGHBORHOOD!!Unaccountable care, lack of organization, DO NOT GO THERE ALONE !! Be wise when you pay for care, KNOW WHAT YOU BUY!!
- 9. Coordination -- we do NOT know how to play as a team“ We don't have a health care delivery system in this country. We have an expensive plethora of uncoordinated, unlinked, micro systems, each performing in ways that too often create sub-optimal performance, both for the overall health care infrastructure and for individual patients." George Halvorson, from “Healthcare Reform NowSaudi Arabia’s King Abdulaziz traveled to the U.S. to receive treatment slipped disc
- 10. “We do heartsurgery more often than anyone, but we need to, because patients are not given the kind of coordinated primary care that would prevent chronic heart disease from becoming acute.” George Halvorson (CEO Kaiser) from “Healthcare Reform Now”
- 11. The most importanttool - mind of the Family Physician focused on two things, relationship, Difficult diagnostic dilemmas A long-term comprehensive relationship with your Personal Physician empowered with the right tools and linked to your care team can result in better overall family health…
- 12. The Joint Principles:Patient Centered Medical HomePersonal physician - each patient has an ongoing relationship with a personal physiciantrained to provide first contact, and continuous and comprehensive care
- 13. Physician directed medicalpractice – the personal physician leads a team of individuals at the practice level who collectively take responsibility for the ongoing care of patients
- 14. Whole person orientation– the personal physician is responsible for providing for all the patient’s health care needs or arranging care with other qualified professionals
- 15. Care is coordinatedand integrated across all elements of the complex healthcare community- coordination is enabled by registries, information technology, and health information exchanges
- 16. Quality and safetyare hallmarks of the medical home- Evidence-based medicine and clinical decision-support tools guide decision-making; Physicians in the practice accept accountability voluntary engagement in performance measurement and improvementEnhanced access to care is available - systems such as open scheduling, expanded hours, and new communication paths between patients, their personal physician, and practice staff are used Payment appropriately recognizes the added value provided to patients who have a patient-centered medical home- providers and employers work together to achieve payment reform 12
- 17. The Quadruple AimReadiness,Experience of Care, Population Health, CostPer Capita CostPopulationHealthThe System Integrator Creates a partnership across the medical neighborhood Drives PCMH primary care redesignOffers a utility for population health and financial managementSystem IntegratorPatientExperienceProductivity
- 18. You need aCaptain for the ship
- 19. You need aplace of command and control
- 20. You need ahorizontal platform from which to launch vertical weapon systems
- 21. You need somewhereand someone to hold accountableIf you scan the world for value based healthcare, you will find a common element: a relationship-based team with a project manager!A comprehensivist that can command and control in an accountable system. So simple!So much!
- 22. Team-Based HealthcareDeliveryPopulationHealth Accessto CarePatientis the centerof theMedical HomeAdvanced IT SystemsPatient-Centered CareDecision Support ToolsRefocused Medical TrainingPatient & Physician FeedbackEnhancing Health and the Patient ExperienceMedical Home ModelModel adapted from theNNMC Medical Home
- 23. Defining the CareSuperbAccess to CareTeam CarePatient Engagement in CarePatient FeedbackClinical Information SystemsPublically Available InformationCare Coordination
- 24. Smarter Healthcare…36.3% Dropin hospital days32.2% Drop in ER use 9.6% Total cost 10.5% Inpatient specialty care costs are down18.9% Ancillary costs down 15.0% Outpatient specialty downOutcomes of Implementing Patient Centered Medical Home Interventions: A Review of the Evidence from Prospective Evaluation Studies in the US, K. Grumbach & P. Grundy, November 16th 2010
- 25. OPM $39 BillionBook with Accountable Care 24-7 clinician phone response
- 26.
- 27. Provide care managementand coordination by specially-trained team members.
- 28. Use an EHRwith decision support.
- 29. Use CPOE forall orders, test tracking, and follow-up.
- 30. Medication reconciliation forevery visit.
- 31. Prescription drug decisionsupport.
- 32.
- 33. Pre-visit planning andafter-visit follow-up for care management.
- 34. Offer patient self-managementsupport.
- 35. Provide a visitsummary to the patient following each visit.
- 36. Maintain a summary-of-carerecord for patient transitions.
- 37.
- 38.
- 39. The development ofcare plans.
- 40. Performance outcome measures.
- 41. Trends thisweek Highmark Inc. Patient-Centered Medical Home Program Designed to Improve Coordination Adirondack Region Medical Home Pilot Somava Stout, MD, Vice President for Patient-Centered Medical Home Development at Cambridge Health Alliance (CHA),Horizon PCMH NJ (BCBS NJ) Army Screaming eagle PCMH
- 42. Corporate Concierge PCMHThe private clinic is for the employees and Families on or near site From 10.2% to 23.7% of company care OneAmerica to Open PCMH Wellness ClinicPerdue opens 15th PCMHCentral Louisiana Family Health and Wellness Center. Martin Companies and Gilchrist Construction Co and 23 other companies
- 43. PCMH in ActionVermont “Blueprint” model A Coordinated Health SystemHospitalsCommunity Care TeamNurse CoordinatorSocial WorkersDieticiansCommunity Health WorkersCare CoordinatorsPublic Health PreventionHEALTH WELLNESSPCMHHealth IT FrameworkSpecialistsGlobal Information FrameworkPCMHEvaluation FrameworkPublic Health PreventionOperations
- 44. Vermont Financial ImpactVermontFinancial Impact
- 45. Sharp Community MedicalGroup: Care Transformation ModelAccountable Community Accountable Care OrganizationEnterprise Level ActivitiesPatient-Centered Medical HomePatient
- 46. PCMH is non-political– the right POV for delivery transformation “We never abandoned advocating newModels of care. We’ve long pushed folksto realize that Delivery reform is the key.”The patient-centered medical home iscore.“We included the attached chapter on PCMH in our book. and have a new publication on ACOs coming out in January.”
- 47. OR? …Requires aSmarter Healthcare WorkforceWhere do you train the MHS Workforce?
- 49. Payment reform requiresmore than one method, you have dials, adjust them!!!fee for health”“fee for outcome”“fee for process”“fee for belonging“fee for service” “fee for satisfaction”
- 50. Technology Enables theProgression to Clinical Integration and Accountable Care “Accountable Care Enablement”“Clinical Integration Enablement”Risk , UM & Care Management Financial & Utilization AnalyticsFinancial & Utilization AnalyticsCare ManagementCare Management “Meaningful Use Enablement”Patient Health RecordPatient Health RecordClinical Quality MetricsClinical Quality MetricsClinical Quality MetricsRegistry &Population MgmtRegistry &Population MgmtRegistry &Population MgmtEMR / PMSEMR / PMSEMR / PMSTeam based care and workflow
- 51.
- 52.
- 53.
- 54.
- 55. Identify gaps incare
- 56. Price / managerisk
- 57. Create a sustainableeconomic modelRecommendationsBuild the foundation, the horizontal platform, a place of accountability - PCMH
- 58. Really engage yourpatients find out what they need and become very patient centered
- 59. Integrate value basepurchasing with PCMH in your plan designee (understand what the buyer wants)
- 60. Stop teaching thepast you are in a world of Data, teams, actionable information
- 61. Integrate Health andSick care
- 62. GIVE US LEADERSHIP- SHOW US THE WAY!