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The Rocky Road Toward Universal Health Insurance Coverage in the USA . Fred Ralston, Jr. MD, FACP President, American College of Physicians. The past: How payment for health care has changed over the past 100 years
Fred Ralston, Jr. MD, FACP
President, American College of Physicians
The past: How payment for health care has changed over the past 100 years
The future: Understanding the Patient-Centered Medical Home: What Is It? What Can It Offer Patients, Physicians, and Those Paying for Health Care?
American Medical Education 100 Years after the Flexner Report N Engl J Med 2006;355:1339-44
After a visit to the Royal College of Physicians in London in 1913, Dr. Heinrich Stern tried to invoke enthusiasm in his colleagues for a similar organization in the United States. But it was two years before Dr. Stern could gather enough physicians—11—that he felt necessary to launch the new organization, the American College of Physicians.
“Americans always want to do the right thing — after they have tried everything else.”
Roosevelt believed that no country could be strong whose people were sick and poor
1912: Roosevelt campaigned on a platform that called for mandatory health insurance for workers
their role in providing social benefits Samuel Gompers
hearings and proposes single-payer plan
46 million uninsured increased
popular support for HI reform
and drug companies
The present – an unsustainable health care delivery system that overvalues procedures and undervalues prevention and primary care
Is there a way to align incentives in a way where patients, physicians and insurers want the right treatment at the right time for everyone?
The Patient-Centered Medical Home: What Is It? What Can It Offer Patients, Physicians, and Those Paying for Health Care?
*Starfield, B., et al: The Milbank Quarterly 2005; 83:457-502
**Gulliford, J Public Health Med 2002; 24:252-4
Dartmouth Atlas of Health Care, Variation among States in the Management of Severe Chronic Illness, 2006
“Not surprisingly, those patients with the strongest relationships to specific primary care physicians were more likely to receive recommended tests and preventive care. In fact, this sense of connection with a single doctor had a greater influence on the kind of preventive care received than the patient’s age, sex,
race or ethnicity.”
How Connected Are You to Your Doctor?
Patient–Physician Connectedness and Quality
of Primary Care
Steven J. Atlas, MD, MPH; Richard W. Grant, MD, MPH;
Timothy G. Ferris, MD; Yuchiao Chang, PhD; and
Michael J. Barry, MD 3 March 2009 | Volume 150 Issue 5 | Pages 325-335
Medical Home Care
My patients are those who make appointments to see me
Our patients are those who are registered in our medical home
Care is determined by today’s problem and time available today
Care is determined by a proactive plan to meet health needs, with or without visits
Care varies by scheduled time and memory or skill of the doctor
Care is standardized according to evidence-based guidelines
I know I deliver high quality care because I’m well trained
We measure our quality and make rapid changes to improve it
Patients are responsible for coordinating their own care
A prepared team of professionals coordinates all patients’ care
It’s up to the patient to tell us what happened to them
We track tests and consultations, and follow-up after ED and hospital
Clinic operations center on meeting the doctor’s needs
An interdisciplinary team works at the top of our licenses to serve patients
Source: Adapted with permission by IBM from Daniel F. Duffy, M.D.
Providers 333,000 primary care
Most of the Fortune 500
80 Million lives
Patient-Centered Medical Home
paymentwith the added valve and therapeutic
Marillac’s Integrated Care Patients (PCMH)
Permission from Horizon Blue Cross Blue Shield and Partners in Care, Corp.
Group Health’s experience in a prototype clinic suggests that primary care enhancements, in the form of the medical home, hold promise for
Paper examines the effects of the medical home prototype at twenty-one to twenty-four months after implementation on
Results show improvements in patients’ experiences, quality, and clinician burnout through two years.
Patients in the medical home experienced
Other clinical specialists
Bodenheimer, T: Coordinating Care – A Perilous Journey through the Health Care System. NEJM 2008;358:10
Cost: Readiness assessment = $80
NCQA application fee: varies by size of practice from $450 for 1 physician to $2,700 for 6+
Organizes charts (paper or electronic) to facilitate team-based care and tracking age-appropriate and condition-specific interventions
Identifies key clinical conditions among population served & follows evidence-based guidelines
Encourages and provides support for patient/family self-management
Addresses health literacy issues
Tracks tests & referrals to assure completion
Collects and reports on quality & satisfaction data to practice
Level 1: 25-49 Points
Fred Ralston, Jr. MD FACP
Private Practice General Internal Medicine
Fayetteville Medical Associates
207 South Elk Avenue
Fayetteville, Tennessee 37334
American College of Physicians