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ONC and PCMH 2011,[object Object],Paul Grundy, MD, MPH, FACOEM, FACPM IBM Director Healthcare TransformationPresident Patient Centered Primary Care Collaborative,[object Object],Paul Grundy MD, MPH	,[object Object],IBM International Director Healthcare Transformation,[object Object],Trip to Denmark  July 10 2009 ,[object Object]
Reinventing Medicaid findings are Outstanding,[object Object],Oklahoma's patient-centered medical home initiative has reduced Medicaid costs $29 per patient per year from 2008 to 2010. Moreover, use of evidence-based primary care, including screening for breast and cervical cancer, increased. ,[object Object],The Colorado initiative expanded access to care. Before the initiative, only 20 percent of pediatricians in the state accepted Medicaid; as of 2010, 96 percent and did and at a lower cost to the state. ,[object Object],Vermont, inpatient care use and related per-person per-month costs decreased 21 percent and 22 percent, respectively, from July 2008 to October 2010. ER  use and related per-person per-month costs decreased 31 percent and 36 percent, respectively.  ,[object Object],Patient Centered Medical Home in Washington in State Acute care spending there was 18 percent below the national average. Inpatient stays per beneficiary were 35 percent below the national average. ,[object Object],The Bottom Line in Medicaid ,[object Object],PCMH starting to show an impact in access to care, quality, and cost control.,[object Object],Citation -- M. Takach, "Reinventing Medicaid: State Innovations to Qualify and Pay for Patient-Centered Medical Homes,[object Object], Show Promising Results," Health Affairs, July 2011 30(7):1325–34. ,[object Object]
Out in July 2011 ,[object Object],BCBS MA  6% decrees cost (NEJM)    ,[object Object],BCBS Mi 2670 physician (BIG study),[object Object]
MGMA: 70% of Practices at Least Interested in Becoming Patient Centered Medical Homes,[object Object],13 to 20 % are already on the road ,[object Object],Some states Michigan, Minnesota, Maryland, RI, VT 50% already are well on the road !!  ,[object Object],Standard of care in the VA, DOD,[object Object],IBM $ 60 per Member BCBS HI 14.6%   ,[object Object],^,[object Object]
Outside Hospital video clip ,[object Object]
Who was the ,[object Object],Shooter’s Doctor? ,[object Object],Population management,[object Object],Accountability ,[object Object]
Why Innovate                  Affordability,[object Object],$30,000,[object Object],+166%,[object Object],$25,000,[object Object],$20,000,[object Object],$15,000,[object Object],+118%,[object Object],$10,000,[object Object],$4,918,[object Object],$5,000,[object Object],$0,[object Object],2001,[object Object],2009,[object Object],2019,[object Object], - Employee Payroll Contributions,[object Object],- Employer Cost,[object Object],- Employee Out of Pocket Expenses,[object Object],a,[object Object],The Elephant in the room,[object Object],$28,530,[object Object],Costs continue their upward climb…,[object Object],…with employers still picking up much of the tab…,[object Object],$10,743,[object Object]
Health care is a business issue, not a benefits issue,[object Object]
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!!”,[object Object],You the AHC’s - Unaccountable Care Organizations  PART of this problem ,[object Object],* Peter A. Muennig and Sherry A. Glied Health Affairs  Oct. 7, 2010,[object Object]
Don’t handle your care needs in a BAD MEDICAL NEIGHBORHOOD!!,[object Object],Unaccountable care, lack of organization, DO NOT GO THERE ALONE !! ,[object Object],Be wise when you pay for care, KNOW WHAT YOU BUY!!,[object Object]
Coordination --  we do NOT know how to play as a team,[object Object],“ 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,[object Object]
“We do kidney transplants and dialysis more often than anyone, but we need to, because patients are not given the kind of coordinated primary care that would prevent chronic complications of renal and heart disease from becoming acute.”,[object Object], George Halvorson (CEO Kaiser)     from “Healthcare Reform Now”,[object Object]
The Diabetic needs A long-term comprehensive relationship with a  Personal Physician empowered with the right tools and linked to their care team. ,[object Object]
The Joint Principles: Patient Centered Medical Home,[object Object],[object Object]
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,[object Object],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 ,[object Object],[object Object],14,[object Object]
The Quadruple AimReadiness, Experience of Care, Population Health, Cost,[object Object],Per Capita Cost,[object Object],Population,[object Object],Health,[object Object],The System Integrator ,[object Object],Creates a partnership across the medical neighborhood ,[object Object],Drives PCMH primary   care redesign,[object Object],Offers a utility for population health and financial management,[object Object],System Integrator,[object Object],Patient,[object Object],Experience,[object Object],Productivity ,[object Object]
[object Object]
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,[object Object]
Team-Based ,[object Object],HealthcareDelivery,[object Object],Population,[object Object],Health ,[object Object],Access to Care,[object Object],Patient,[object Object],is the centerof theMedical Home,[object Object],Advanced IT Systems,[object Object],Patient-Centered Care,[object Object],Decision Support Tools,[object Object],Refocused Medical Training,[object Object],Patient & Physician Feedback,[object Object],Enhancing Health                                 and the Patient Experience,[object Object],Medical Home Model,[object Object],Model adapted from theNNMC Medical Home,[object Object]
Defining the Care Centered on Patient ,[object Object],Superb Access             to Care,[object Object],Team Care,[object Object],Patient Engagement in Care,[object Object],Patient Feedback,[object Object],Clinical Information Systems,[object Object],Publically Available Information,[object Object],Care Coordination,[object Object]
Smarter Healthcare…,[object Object],36.3% 	Drop in hospital days,[object Object],32.2% 	Drop in ER use ,[object Object],9.6%	Total cost ,[object Object],10.5%	Inpatient specialty care costs are down,[object Object],18.9%	Ancillary costs down ,[object Object],15.0%	Outpatient specialty down,[object Object],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 ,[object Object]
	Patient Centered Medical Home in Washington in State provided great example of how states can lower spending by reducing hospital care and expanding access to primary care providers. Acute care spending there was 18 percent below the national average. Inpatient stays per beneficiary were 35 percent below the national average. ,[object Object],Ref Health Affairs 7 July 2011 .http://healthaffairs.org/blog/2011/07/07/medicaid-spending-variations-driven-more-by-volume-than-price-says-study-in-new-health-affairs/http://content.healthaffairs.org/content/30/7/1316.full,[object Object]
OPM $39 Billion Book with Accountable Care,[object Object],Patient at the center,[object Object],[object Object]
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.

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