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Patient Centric Primary Care Roundtable

AAFP AAP ACP AOA Joint Principles of the Patient-Centered Medical Home Rosemarie Sweeney MPA Vice President, Public Policy and Practice Support American Academy of Family Physicians. Patient Centric Primary Care Roundtable. Primary Care

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Patient Centric Primary Care Roundtable

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  1. AAFP AAP ACP AOA Joint Principles of the Patient-Centered Medical Home Rosemarie Sweeney MPA Vice President, Public Policy and Practice Support American Academy of Family Physicians Patient Centric Primary Care Roundtable

  2. Primary Care The provision of first contact, person-focused ongoing care over time that meets the health—related needs of people, referring only those too uncommon to maintain competence, and coordinates care when people receive service services at other levels of care. Starfield 09/04 Patient Centric Primary Care Roundtable

  3. Most primary care in the US is provided by physicians who have completed residency training in family medicine, generalinternal medicine and pediatrics. Patient Centric Primary Care Roundtable

  4. Why is Primary Care Important • Better health outcomes • Lower costs • Greater equity in health Starfield 09/04 Patient Centric Primary Care Roundtable

  5. Patients who have an ongoing relationship with a primary care physician have better outcomes and lower costs (1) • When care is managed effectively in the ambulatory setting by primary care physicians, patients with chronic diseases like diabetes, CHF, and adult asthma have fewer complications, leading to fewer avoidable hospitalizations (2) • Starfield, presentation to Commonwealth Fund Roundtable on Primary Care, October 2006 • Commonwealth Fund, Chartbook on Medicare, 2006 Patient Centric Primary Care Roundtable

  6. In other words… A Patient-Centered Medical Home Patient Centric Primary Care Roundtable

  7. What is the patient centered medical home? Joint principles from AAFP, AAP, ACP and AOA outline the model, attributes, and payment structure Patient Centric Primary Care Roundtable

  8. Each patient has an ongoing relationship with a personal physician rained to provide provide first contact, continuous and comprehensive care Patient Centric Primary Care Roundtable

  9. The physician directed medical practice works as a team of individuals who collectively take responsibility for the ongoing care of patients

  10. Whole person orientation The medical home provides for all the patient’s health care needs or takes responsibility for arranging care with other qualified professionals Patient Centric Primary Care Roundtable

  11. Care for all stages of life • Acute care • Chronic care • Preventive services • End of life care Patient Centric Primary Care Roundtable

  12. Care is coordinated across health care system and community • Subspecialty care • Hospitals • Home health • Nursing home • Family • Community based services Patient Centric Primary Care Roundtable

  13. Care is facilitated by: -Registries -Information Technology -Health Information Exchange using systems-based approaches to improve care coordination and management Patient Centric Primary Care Roundtable

  14. Quality and Safety are Hallmarks of the medical home - Patient Centered Outcomes - Evidence-based medicine - Clinical decision support tools Patient Centric Primary Care Roundtable

  15. Physicians engage in continuous quality improvement and performance measurement and improvement Information technology supports optimal patient care, performance measurement Patient Centric Primary Care Roundtable

  16. Convenience for patients - Open scheduling (same day appointments) - Extended hours - Email communication, phone consults, etc. Patient Centric Primary Care Roundtable

  17. Accountability to patients and payors Practices participate in a voluntary recognition process to demonstrate they have the capabilities to provide services of the patient centered medical home Patient Centric Primary Care Roundtable

  18. Assures accountability to the purchaser (employer) and the consumer (employee) on quality, patient satisfaction and cost of care measures Patient Centric Primary Care Roundtable

  19. Payment recognizes the added value provided to patients with patient centered medical home Patient Centric Primary Care Roundtable

  20. Care management work that falls outside the office visit • Care coordination within practice and between consultants, other providers • Adoption and use of HIT for quality improvement • Provision of enhanced communication (email, phone consultation) Patient Centric Primary Care Roundtable

  21. Payment Structure Fee for service for face to face visits Care management fee to recognize added value Additional payment for achieving measurable and continuous quality improvement Patient Centric Primary Care Roundtable

  22. RESULTS: • Employees will get better care • Employees will have higher patient satisfaction • Employees may need to take less time off from work • Employers will have lower costs Patient Centric Primary Care Roundtable

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