FFM: Base case = 5 physicians; initial purchase of equipment & supplies (capital costs); new personnel/training; lost productivity, EMR transition
Overview of the Patient Centered Medical Home (PCMH) Neil Kirschner, Ph.D Senior Associate, Regulatory and Insurer Affairs Division of Government Affairs & Public Policy American College of Physicians Email: firstname.lastname@example.org Phone: 202-261-4535 Presentation to the Maryland Chapter American College of Physicians November 20, 2008
Increasingly aging and chronically ill population with payment system that doesn’t recognize services found necessary for essential care e.g. care coordination, evidence-based population management, disease self management
Decreased Interest in Primary Care
The number of new students entering into primary care is decreasing and physicians who have chosen the field are disproportionately leaving compared to other specialties.
Both domestic and international data indicating that higher proportion of primary care physicians related to higher healthcare quality and lower costs.
A Joint Proposed Solution The Patient-Centered Medical Home (PCMH)
Modern “medical home” concept originally in Pediatric literature in the 1960’s—a central source of care for “Special Needs” children.
AAFP—Future of Family Medicine Project (2004) “Personal Medical Home”
ACP—Advanced Medical Home (2006)
Key elements of a PCMH are described in a March 2007 joint statement of principles from ACP, AAFP, AAP and AOA. Often referred to as the “Joint Principles”.
Nexus of patient-centered care, primary care and chronic care model concepts
Varying Assumptions… “apples to oranges” comparisons
Future of Family Medicine 2004: Transition costs of $23,000 - $90,000 per physician*
$15 PMPM for patients with chronic conditions
Michael Bailit—review of PCMH estimates $3.00 - $9.00 pmpm**
Initial investment of $100,000/FTE
On-going expenses of $150,000/FTE
* http://www.annfammed.org/cgi/reprint/2/suppl_3/s1 ** [email_address] ***Deloitte: The Medical Home, Disruptive Innovation for a New Primary Care Model Accessed at: http://www.deloitte.com/dtt/cda/doc/content/us_chs_MedicalHome_w.pdf