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Extracting Value
Patient Centered Medical Home
Hillcrest 2015 Winter CME Update
Paul Grundy MD, MPH - IBM Director, Health...
“Godfather” of the Patient Centered Medical Home
IBM Global Director Healthcare Transformation
President of PCPCC
Ambassad...
The System Integrator
Creates a partnership across the
medical neighborhood
Drives PCMH primary care redesign
Offers a uti...
Hillcrest HealthCare System: Changing lives for the better, together
“First Follower: Leadership Lessons from Dancing Guy”
– BUT -where the delivery system works
– a Patient in a trusting relation with a
healer who is a comprehensivist where
the...
36.3% Drop in hospital days
32.2% Drop in ER use
12.8% Increase Chronic Medication use
-15.6% Total cost
10.5% Drop Inpati...
•9.9 percent lower rate of adult ER visits
•27.5 percent lower rate of adult ambulatory care sensitive
inpatient stays
•11...
17 found
improvements in
cost
24 improvements in
quality
10 found
improvements in
access
8 found
improvements in
satisfact...
Beyond Flexner --- Driven by
Actionable - Personalized Data
USA 2012
Ogden UT
Watson is ushering in a new
era of computing
Tabulating
Systems Era
Programmable
Systems Era
Cognitive
Systems Era
1900
19...
MobileFirst Patient Consumer
Preventive
Medicine
Medication
Refills Acute Care
Nursing
Test Results
Master Builder
DOCTOR
Source: Southcentral Foundati...
Source: Southcentral Foundation, Anchorage AK
PCMH Parallel Team Flow Design: the glue is real data, not a doctor’s brain
...
Healthcare Will Transform --- Family Medicine for America’s Health
Data Driven
Every person has a plan
Team based
Managing...
Today’s Care PCMH Care
My patients are those who make appointments to see
me
Our patients are the population community
Car...
Superb Access to
Care
Patient Engagement in
Care
Clinical Information
Systems, Registry
Care Coordination
Team Care
Commun...
HIT
Infrastructure:
EHRs and
Connectivity
Primary Care
Capacity:
Patient
Centered
Medical Home
Operational
Care
Coordinati...
Payment reform requires more than one method, you
have dials, adjust them!!!
“fee for health”
“fee for value”
“fee for out...
Nearly 1/3 traditional Medicare tied to alternative reimbursement models—such as Patient
Centered Medical home (PCMH)/ acc...
Businesses are no longer accepting cost-shifting.
40% of commercial in-network payments are value-based up from 11% -- 201...
Transformation is Here
• HHS to spend $840 million on readying practices for value-based pay. -- Part of the 10 Billion
• ...
Benefit Redesign - Patient Engagement
Different Strategies for Different Healthcare Spend Segments
% Total
Healthcare
Spen...
Public Health
Prevention
Specialists
PCMH 2.0 in Action
Community Care Team
Nurse Coordinator
Social Workers
Dieticians
Co...
Thank you
Apply new insights from
interactions and outcomes
to enable continuous
transformation
LEARNING
Identify and influence indi...
need to move from traditional care provider to health partner
if your do not choose innovation (play a better game) you wi...
How many patients can you see?
How many patients’ problems can you solve?
How can we encourage and convince patients to ge...
Keystone colorado jan 2015
Keystone colorado jan 2015
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Keystone colorado jan 2015
Keystone colorado jan 2015
Keystone colorado jan 2015
Keystone colorado jan 2015
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Keystone colorado jan 2015
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Keystone colorado jan 2015

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Keystone colorado jan 2015

  1. 1. Extracting Value Patient Centered Medical Home Hillcrest 2015 Winter CME Update Paul Grundy MD, MPH - IBM Director, Healthcare Transformation @Paul_PCPCC https://twitter.com/Paul_PCPCC
  2. 2. “Godfather” of the Patient Centered Medical Home IBM Global Director Healthcare Transformation President of PCPCC Ambassador for Denmark Healthcare Member Institute of Medicine Member Board ACGME Professor Univ. of Utah Department Family Medicine Winner NCQA national Quality Award A Leader of MOH level taskforce primary care transformation 8 nations: USA, Canada, New Zealand, Australia, Holland, Denmark, UK, Belgium, Univ. of California MD, John Hopkins Trained Paul Grundy MD MPH Bio
  3. 3. The System Integrator Creates a partnership across the medical neighborhood Drives PCMH primary care redesign Offers a utility for population health and financial management Away from Episode of Care to Management of Population WITH DATA Community Health Population Health System Integrator Patient Experience Per Capita Cost Public Health @Paul_PCPCC https://twitter.com/Paul_PCPCC
  4. 4. Hillcrest HealthCare System: Changing lives for the better, together “First Follower: Leadership Lessons from Dancing Guy”
  5. 5. – BUT -where the delivery system works – a Patient in a trusting relation with a healer who is a comprehensivist where the patients data is in charge” In much of the world, no one is in charge. And the result is the most wasteful and Unsustainable
  6. 6. 36.3% Drop in hospital days 32.2% Drop in ER use 12.8% Increase Chronic Medication use -15.6% Total cost 10.5% Drop Inpatient specialty care costs 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 - PCPCC Oct 2012 Smarter Healthcare
  7. 7. •9.9 percent lower rate of adult ER visits •27.5 percent lower rate of adult ambulatory care sensitive inpatient stays •11.8 percent lower rate of adult primary care sensitive ER visits •8.7 percent lower rate of adult high-tech radiology usage •14.9 percent lower rate of pediatric ER visits •21.3 percent lower rate of pediatric primary-care sensitive ER visits 24 July 2014 Michigan Blues’ patient-centered medical home program shows statewide transformation of care YEAR 6 4,022 primary care doctors at 1,422 practices around the state in its sixth year of operation. These practices care for more than 1.2 million BCBSM members.
  8. 8. 17 found improvements in cost 24 improvements in quality 10 found improvements in access 8 found improvements in satisfaction 24 found improvements in utilization
  9. 9. Beyond Flexner --- Driven by Actionable - Personalized Data
  10. 10. USA 2012 Ogden UT
  11. 11. Watson is ushering in a new era of computing Tabulating Systems Era Programmable Systems Era Cognitive Systems Era 1900 1950 2011
  12. 12. MobileFirst Patient Consumer
  13. 13. Preventive Medicine Medication Refills Acute Care Nursing Test Results Master Builder DOCTOR Source: Southcentral Foundation, Anchorage AK Behavioral Health Case Manager Medical Assistants Chronic Disease Monitoring Practice transformation away from episode of care
  14. 14. Source: Southcentral Foundation, Anchorage AK PCMH Parallel Team Flow Design: the glue is real data, not a doctor’s brain Medication Refills Chronic Disease Monitoring Test Results Acute Care Preventive Medicine Point of Care Testing Acute Mental Health Complaint Chronic Disease Compliance Barriers Healthcare Support Team Behavioral Health Medical Assistants Case Manager Clinician
  15. 15. Healthcare Will Transform --- Family Medicine for America’s Health Data Driven Every person has a plan Team based Managing a population down to the person .
  16. 16. Today’s Care PCMH Care My patients are those who make appointments to see me Our patients are the population community Care is determined by today’s problem and time available today Care is determined by a proactive plan to meet patient needs with or 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 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
  17. 17. Superb Access to Care Patient Engagement in Care Clinical Information Systems, Registry Care Coordination Team Care Communication Patient Feedback Mobile easy to use and Available Information Defining the Care Centered on Patient
  18. 18. HIT Infrastructure: EHRs and Connectivity Primary Care Capacity: Patient Centered Medical Home Operational Care Coordination: Embedded RN Coordinator and Health Plan Care Coordination $ Value/ Outcome Measurement: Reporting of Quality, Utilization and Patient Satisfaction Measures Value-Based Purchasing: Reimbursement Tied to Performance on Value (quality, appropriate utilization and patient satisfaction) Achieve Supportive Base for ACOs and Bundled Payments with Outcome Measurement and Health Plan Involvement Trajectory to Value Based Purchasing: Achieving Real Care Coordination and Outcome Measurement Source: Hudson Valley Initiative
  19. 19. Payment reform requires more than one method, you have dials, adjust them!!! “fee for health” “fee for value” “fee for outcome” “fee for process” “fee for belonging “fee for service” “fee for satisfaction”
  20. 20. Nearly 1/3 traditional Medicare tied to alternative reimbursement models—such as Patient Centered Medical home (PCMH)/ accountable care organizations (ACOs) or bundled payments—by the end of 2016 50% by end 2018 And end of 2018 90% of traditional Medicare payments to quality or value through programs such as the Partnership for Patients Hospital, Value Based Purchasing and the Hospital Readmissions
  21. 21. Businesses are no longer accepting cost-shifting. 40% of commercial in-network payments are value-based up from 11% -- 2012 Government and private insurers increasingly are paying for value and outcomes, not volume; they are also employing new payment models for hospitals and clinicians. Half of these payments are “at risk” and half are upside only.
  22. 22. Transformation is Here • HHS to spend $840 million on readying practices for value-based pay. -- Part of the 10 Billion • The Transforming Clinical Practice Initiative will invest $840 million over four years to support 150,000 clinicians. • It will provide a combination of incentives, tools and information to encourage doctors to team with peers and others to transition to value-based services. • Momentum building toward value-based payment methods, this initiative hopes to leverage the success of leading practices, health systems and professional orgs to coach others in how to best move to value-based reimbursement. It fits well into the broader federal strategy. • Transforming Clinical Practice • Group practices health systems and Medical Societies • Impact 150,000 clinicians • AND You ARE READY!!!!!!!
  23. 23. Benefit Redesign - Patient Engagement Different Strategies for Different Healthcare Spend Segments % Total Healthcare Spend % of Members Those who are well or think they are well Those with chronic illness Those with severe, acute illness or injuries
  24. 24. Public Health Prevention Specialists PCMH 2.0 in Action Community Care Team Nurse Coordinator Social Workers Dieticians Community Health Workers Care Coordinators Public Health Prevention HEALTH WELLNESS Hospitals PCMH PCMH Health IT Framework Global Information Framework Evaluation Framework Operations A Coordinated Health System
  25. 25. Thank you
  26. 26. Apply new insights from interactions and outcomes to enable continuous transformation LEARNING Identify and influence individuals and populations, and recognize intervention opportunities INTERVENTION COORDINATION Deliver care and monitor progress across clinical and social requirements COLLABORATION Assess and engage individuals and stakeholders to drive individualized care plans Drive evidence-based and standardized care planning KNOWLEDGE WELLNESS A comprehensive approach helps reduce costs while improving care
  27. 27. need to move from traditional care provider to health partner if your do not choose innovation (play a better game) you will be forced into disruption ( game Changed for you). Honest you can see it coming and some places is already there Millennials are already finding the convenience, economics and technology in powerful virtual engagement compelling so you can chose innovation or disruption. Virtual access become a required defensive strategy Primary Care team engaged in virtual augmented relationship – or your history loss the relationship.
  28. 28. How many patients can you see? How many patients’ problems can you solve? How can we encourage and convince patients to get required prevention? How can we create systems that significantly increase that patients get required prevention? How often should a physician see a patient to optimally monitor a condition? What is the best way to optimally monitor a condition? Asking New Questions From To From To From To *Source: 2014 Kaiser Permanente Jack Cochran

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