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THE PATIENT-CENTERED MEDICAL HOME: ITS ROLE IN HEALTHCARE REFORM

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THE PATIENT-CENTERED MEDICAL HOME: ITS ROLE IN HEALTHCARE REFORM

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    1. THE PATIENT-CENTERED MEDICAL HOME: ITS ROLE IN HEALTHCARE REFORM

    2. Healthcare Reform (U.S.)

    4. Accessibility Affordability Sustainability The contribution of the patient-centered medical home (PCMH) is what it contributes to addressing these issues.

    5. Given the shortage of primary care providers, can the PCMH respond to the increased demand for care? In what ways can the PCMH make care more affordable while maintaining or improving quality? To what extent can the PCMH help promote sustainable changes in how healthcare is delivered over time?

    6. An entity that provides patients with a primary care team that has the capabilities to provide personalized, whole person, coordinated care across conditions, episodes, providers, and settings over time. Endorsed and supported by the American College of Physicians, the American Academy of Family Physicians, the American Academy of Pediatrics, and the American Osteopathic Association

    7. Four Cornerstones

    10. Payment Reform

    11. Accountable Care Organizations

    12. Integrated Delivery Systems (Kaiser-{Permanente, Group Health Cooperative of Puget Sound, Henry Ford Health System, Intermountain Health System, Trinity Health System) Multi-Specialty Group Practices (Mayo Clinic, Billings Clinic, Cleveland Clinic, Virginia Mason, Marshfield Clinic) Physician Hospital Organizations (Advocate, Middlesex) Independent Practice Associations (IPAs – Hill Physicians Group, Health Partners in Los Angeles, many others) “Virtual” Physician Organizations (Community Care of North Carolina, Grand Junction, Colorado, Humboldt County, California)

    25. Key Linkage PCMHs are the basic Building blocks for ACOs. PCMHs are the foundation. ACOs and PCMHs are synergistic.

    28. COLD WATER! Not many physician practices today would meet the standards for becoming a PCMH.

    32. What Is the Evidence? Quality of Care, Patient Experience, Care Coordination and Access Are Better Reductions in ER Visit and Hospitalizations At Least Cost Neutral Internationally, Systems with Greater Investment in Primary Care Have Better Health Outcomes at Lower Cost

    33. Some Specific Examples Group Health Cooperative of Puget Sound 29% reduction in ER visits; 11% reduction in ambulatory care sensitive admissions versus control sizes Significantly higher patient experience scores and less staff burnout No increase in overall cost Now being implemented in all 26 primary care clinics serving 380,000 patients

    34. Some Specific Examples (Cont’d) Community Care of North Carolina 40% decrease in hospitalizations for asthma and 11% lower ER visits Total savings to Medicaid and SCHIP Programs of $135 million to $400 million Now involves 1300 community-based practice sites and approximately 4500 primary care clinicians throughout North Carolina

    35. Some Specific Examples (Cont’d) Geisinger Proven Health Navigator Model Statistically significant 14% reduction in hospital admissions relative to control and 9% reduction in total costs at 24 months Estimated $3.7 million net savings for a ROI of > 2 to 1 Colorado Medicaid and SCHIP Median annual costs of $785 for PCMH children versus $1000 for controls due to reductions in ER visits and hospitalizations

    37. Some Specific Examples (Cont’d) Intermountain Health Care Absolute reduction of 3.4% in 2 year mortality in comparison with control group focusing on high-risk elderly 10% relative reduction in hospitalizations and even greater among those with chronic illnesses. Net reduction in total costs of $640 per patient per year; $1650 among highest risk patients Now being implemented in 75 practices in 6 states

    39. Patient-Centered Medical Home Design Principles and Change Components PCMH Design Principles The relationship between the primary care physician and patient is at the core. The organization will align to promote and sustain this relationship. The primary care physician will be the leader of the clinical team, be responsible for coordination of services, and will collaborate with patients in care planning. Continuous healing relationships will be proactive and encompass all aspects of health and illness. Patients will be actively informed and encouraged to participate. Access will be centered on patients’ needs, be available by various modes 24/7, and maximize the use of technology. Clinical and business systems will align to achieve the most efficient, satisfying, and effective patient experiences.

    40. Patient-Centered Medical Home Design Principles and Change Components (Cont’d) Structural and Team Change

    41. Patient-Centered Medical Home Design Principles and Change Components (Cont’d) Point-of-Care Changes

    42. Patient-Centered Medical Home Design Principles and Change Components (Cont’d) Patient Outreach Changes

    43. Patient-Centered Medical Home Design Principles and Change Components (Cont’d) Management Changes

    44. PCMHs can be a great source for collaborative education of patients, their families and their clinical team regarding the advances in evidence-based medicine and management. A “home” for continuous learning.

    48. Ultimate success of the patient-centered medical home may lie in the aggregate response to the following question “Is there anything at all that could have gone better today from your point of view in the care that you experienced?” Don Bewick, “What patient-centered care should mean: confession of an extremist”, Health Affairs, May 14, 2009.

    49. Sources Starfield, B., L. Shi, et al. Contribution of primary care to health systems and health. Milbank Q 2005;83(3):457-502. Reid R., Fishman P., Yu O., et al. A patient-centered medical home demonstration: a prospective, quasi-experimental, before and after evaluation. Am J Managed Care 2009 (Sept issue in press). Steiner, B., et al. Community Care of North Carolina: Improving care through community health networks. Ann Fam Med 2008;6:361-367. Dorr, D., Wilcox, A., Brunker C., et al. The effect of technology-supported, multi-disease care management on the mortality and hospitalization of seniors. J Am Geriatr Soc. 2008;56(12):2195-202. Finds updated for presentation at White House roundtable on Advanced Models on Primary Care, August 10, 2009. Rittenhouse, D., Casalino, L., Gillies, R., Shortell, S., and Lau, B. Measuring the medical home infrastructure in large medical groups. Health Affairs. September/October 2008, 27(5):1246-1258. Rittenhouse, D., and Shortell, S. The patient-centered medical home: will it stand the test of health reform?. JAMA 2009;301(19):2038-2040.

    50. THANK YOU!

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