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Ohio may 14 2011

Ohio may 14 2011






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    Ohio may 14 2011 Ohio may 14 2011 Presentation Transcript

    • PCMH for Ohio 2011
      Paul Grundy, MD, MPH, FACOEM, FACPM IBM Director Healthcare TransformationPresident Patient Centered Primary Care Collaborative
      Paul Grundy MD, MPH
      IBM International Director Healthcare Transformation
      Trip to Denmark July 10 2009
    • Who was the
      Shooter’s Doctor?
      Population management
    • You Tube Video
    • Why Innovate Affordability
      - Employee Payroll Contributions
      - Employer Cost
      - Employee Out of Pocket Expenses
      The Elephant in the room
      Costs continue their upward climb…
      …with employers still picking up much of the tab…
    • Health care is a business issue, not a benefits issue
    • The Cause? Mostly due 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
    • 3° Care
      2° Care
      What’s wrong with this picture?
      1° Care
      Every country starts at the base of the pyramid with Wellness Prevention 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° Care
      2° Care
      1° Care, Wellness Prevention
    • Don’t handle your care 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!!
    • 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 Now
      Saudi Arabia’s King Abdulaziz traveled to the U.S. to receive treatment slipped disc
    • “We do heart surgery 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”
    • The most important tool - 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…
    • The Joint Principles: Patient Centered Medical Home
      • Personal physician - each patient has an ongoing relationship with a personal physiciantrained to provide first contact, and continuous and comprehensive care
      • Physician directed medical practice – the personal physician leads a team of individuals at the practice level who collectively take responsibility for the ongoing care of patients
      • 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
      • Care is coordinated and integrated across all elements of the complex healthcare community- coordination is enabled by registries, information technology, and health information exchanges
      • Quality and safety are 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 improvement
      Enhanced 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
    • The Quadruple AimReadiness, Experience of Care, Population Health, Cost
      Per Capita Cost
      The System Integrator
      Creates a partnership across the medical neighborhood
      Drives PCMH primary care redesign
      Offers a utility for population health and financial management
      System Integrator
      • You need a Captain for the ship
      • You need a place of command and control
      • You need a horizontal platform from which to launch vertical weapon systems
      • You need somewhere and someone to hold accountable
    • If 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!
    • Team-Based
      Access to Care
      is the centerof theMedical Home
      Advanced IT Systems
      Patient-Centered Care
      Decision Support Tools
      Refocused Medical Training
      Patient & Physician Feedback
      Enhancing Health and the Patient Experience
      Medical Home Model
      Model adapted from theNNMC Medical Home
    • Defining the Care
      Superb Access to Care
      Team Care
      Patient Engagement in Care
      Patient Feedback
      Clinical Information Systems
      Publically Available Information
      Care Coordination
    • Smarter Healthcare…
      36.3% Drop in hospital days
      32.2% Drop in ER use
      9.6% Total cost
      10.5% Inpatient specialty care costs are down
      18.9% Ancillary costs down
      15.0% Outpatient specialty down
      Outcomes 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
    • OPM $39 Billion Book with Accountable Care
      • 24-7 clinician phone response
      • Provide open scheduling.
      • Provide care management and coordination by specially-trained team members.
      • Use an EHR with decision support.
      • Use CPOE for all orders, test tracking, and follow-up.
      • Medication reconciliation for every visit.
      • Prescription drug decision support.
      • Implement e-prescribing.
      • Pre-visit planning and after-visit follow-up for care management.
      • Offer patient self-management support.
      • Provide a visit summary to the patient following each visit.
      • Maintain a summary-of-care record for patient transitions.
      • Email consultations.
      • Telephone consultations.
      • The development of care plans.
      • Performance outcome
    • Not just employers DOD, OPM goes PCMH
      health coverage to some 10 million jumped from $19 billion in 2001 to $53 billion in the Pentagon's latest budget request.
      OPM -- $40 Billion
      States as employers 17 so far PCMH
      County gov, school boards
      Highmark –PCMH
    • Corporate Concierge PCMH The 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 Clinic
      Perdue opens 15th PCMH
      Central Louisiana Family Health and Wellness Center. Martin Companies and Gilchrist Construction Co and 23 other companies
    • PCMH in Action
      Vermont “Blueprint” model
      A Coordinated
      Health System
      Community Care Team
      Nurse Coordinator
      Social Workers
      Community Health Workers
      Care Coordinators
      Public Health Prevention
      Health IT
      Global Information Framework
      Public Health Prevention
    • Vermont Financial Impact
      Vermont Financial Impact
    • Sharp Community Medical Group: Care Transformation Model
      Accountable Community Accountable Care Organization
      Enterprise Level Activities
      Patient-Centered Medical Home
    • PCMH is non-political – the right POV for delivery transformation
      “We never abandoned advocating new
      Models of care. We’ve long pushed folks
      to realize that Delivery reform is the key.”
      The patient-centered medical home is
      “We included the attached chapter on PCMH in our book. and have a new publication on ACOs coming out in January.”
    • OR?
      …Requires a Smarter Healthcare Workforce
      Where do you train the MHS Workforce?
    • Payment reform requires more 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”
    • Technology Enables the Progression to Clinical Integration and Accountable Care
      “Accountable Care Enablement”
      “Clinical Integration Enablement”
      Risk , UM & Care Management
      Financial & Utilization Analytics
      Financial & Utilization Analytics
      Care Management
      Care Management
      “Meaningful Use Enablement”
      Patient Health Record
      Patient Health Record
      Quality Metrics
      Quality Metrics
      Quality Metrics
      Registry &
      Population Mgmt
      Registry &
      Population Mgmt
      Registry &
      Population Mgmt
      EMR / PMS
      EMR / PMS
      EMR / PMS
      • Team based care and workflow
      • Enable Patients
      • Manage populations
      • Manage performance
      • Digitization & Interoperability
      • Identify gaps in care
      • Price / manage risk
      • Create a sustainable economic model
    • I) if quality care exists in your community, use it
      2) Demand improved primary care (and be willing to pay for the transformation if in the long run it saves you Money and it does it) Communities need to be taught how to recruit and retain a primary care physician. There is a lot of work that has been done on this.
      3) Seek out and use “Patient Centered Medical Homes” for health care
      4) Find physicians who are trying to conquered the digital divide
      5) Find a doctor comfortable with moving into the future with data, populating management,
      6) Demand a focus on quality
      7) Demand provides in your community to collaborate, collaborate, collaborate
      If there is a community health center (CHC), a rural health clinic, and a critical access (or small rural hospital) in your community, encourage collaboration
      8) Encourage mental health and primary care to work together (the Brain is connected to the body)
      9) Work to build a healthy community integrate health and sick care
    • Recommendations
      • Build the foundation, the horizontal platform, a place of accountability - PCMH
      • Really engage your patients find out what they need and become very patient centered
      • Integrate value base purchasing with PCMH in your plan designee (understand what the buyer wants)
      • Stop teaching the past you are in a world of Data, teams, actionable information
      • Integrate Health and Sick care