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What is the Patient-Centered Medical Home Model ? How Will it Benefit Employers? . Bruce Sherman, MD, FCCP, FACOEM NJBGH – October 12, 2010. Do we get what we pay for?. US Ranks for… Cost: 1 Health: 24 Health System Performance: 37 Financial Fairness: 54.
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Bruce Sherman, MD, FCCP, FACOEM
NJBGH – October 12, 2010
US Ranks for…
Health System Performance: 37
Financial Fairness: 54
Americans living longer
Average lifespan 77+ years1
Chronic disease more prevalent
> 40% with chronic conditions have > 12
Quality of care
Patients not getting services & not achieving outcomes
More than 50% of patients with diabetes, hypertension, tobacco use, hyperlipidemia, congestive heart failure, asthma, depression and chronic atrial fibrillation were managed inadequately2
45% of adults did not receive recommended care for prevention, acute illness or chronic conditions3
Sepulveda M, et al: Health Affairs 2008;27:151-158
Patient has ongoing relationship w/ a personal doctor, or other qualified lead practitioner
A Patient Gateway
NOT a Gatekeeper
The doctor leads a team who collectively provide ongoing care.
Team provides all patient care needs or arranges for care with other qualified professionals.
Information technology links all elements of care (e.g. hospital, specialist, home health agency, nursing home) and the patient’s community (e.g. family).
Creates payment structure recognizing added value provided to patients.
Robust partnership among physicians, patients, and their families; evidence-based medicine and CDS support tools guide decision making; IT supports optimal patient care and enhanced communication.
Expanded hours, open scheduling, better communication.
MEDICAL HOME CARE
My patients are those who make appointments to see me
Our patients are those who are registered in our medical home
Patients’ chief complaints or reasons for visit determines care
We systematically assess all our patients’ health needs to plan care
Care is determined by today’s problem and time available today
Care is determined by a proactive plan to meet patient needs without visits
Care varies by scheduled time and memory or skill of the doctor
Care is standardized according to evidence-based guidelines
Patients are responsible for coordinating their own care
A prepared team of professionals coordinates all patients’ care
I know I deliver high quality care because I’m well trained
We measure our quality and make rapid changes to improve it
Acute care is delivered in the next available appointment and walk-ins
Acute care is delivered by open access and non-visit contacts
It’s up to the patient to tell us what happened to them
We track tests & consultations, and follow-up after ED & hospital
Clinic operations center on meeting the doctor’s needs
A multidisciplinary team works at the top of our licenses to serve patients
Slide from Daniel Duffy MD School of Community Medicine Tulsa Oklahoma
“Not surprisingly, those patients with the strongest relationships to specific primary care physicians were more likely to receive recommended tests, and be adherent with medicationsand 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.”
Patient–Physician Connectedness and Quality
of Primary Care
Atlas, SJ Grant RW, et al. Ann Int Med 2009 :150 :325-335
Atlas SJ, et al. Ann Intern Med. 2009;150:325-335.
While other approaches have addressed some PCMH factors, none has addressed them all
P. Grundy, MD. Midwest Business Group on Health, Sept, 2009
Marillac’s Integrated Care Patients (PCMH)
Key physician and practice accountabilities/ value added services and tools
Proactively work to keep patients healthy and manage existing illness or conditions
Coordinate patient care among an organized team of health care professionals
Utilize systems at the practice level to achieve higher quality of care and better outcomes
Focus on whole person care for their patients
Developed by the PCPCC Center for Benefit Redesign and Implementation in partnership with NBCH and the Center’s multi-stakeholder advisory panel.
Guide offers employers and buyers actionable steps as they work with health plans in local markets - over 6000 copies downloaded and/or distributed.
Includes contract language, RFP language and overview of national pilots.
Includes steps employers can take to involve themselves now in local market efforts.
The PCPCC is holding a series of Webinars, sponsored by Pfizer, on the Purchaser Guide.
Patient Centered Primary Care Collaborative“Proof in Practice– A Compilation of Patient Centered Medical Home Pilot and Demonstration Projects” Released October 2009
Developed by the PCPCC Center for Multi-stakeholder Demonstration through a grant from AAFP offering a state-by-state sample of key pilot initiatives.
Offers key contacts, project status, participating practices and market scan of covered lives; physicians.
Inventory of : recognition program used, practice support (technology), project evaluation, and key resources.
Begins to establish framework for program evaluation/ market tracking.
Patient Centered Primary Care Collaborative“A Collaborative Partnership – Resources to Help Consumers Thrive in the Medical Home” Released October 2009
Employer Metrics for Evaluating the Business Value of Patient-Centered Medical Home Programs
Bruce Sherman, MD