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The Patient-Centered Medical Home in the Transformation From Healthcare to Health

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The Patient-Centered Medical Home in the Transformation From Healthcare to Health

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Surgeon General of the Navy VADM Matthew L. Nathan, MC USN

Fortunately, we have a way to address this crisis—the
Patient-Centered Medical Home (PCMH) model launched at Naval Hospital Pensacola and Walter Reed National Military Medical Center, Bethesda, Maryland (formerly the National Naval Medical Center) in 2008. It is now being implemented throughout the Military Health System (MHS) and carries great promise. It provides the clinical framework we need to meet our strategic objectives in terms of quality of care, impact on costs, population health, and readiness. One of the most significant benefits of the team-based, collaborative approach is that it allows us to embed within a primary care environment the psychologists, nutritionists, tobacco cessation specialists, mind-body medicine therapists, and health educators our patients need in order to develop and maintain mindful, healthy behaviors—along with the “mental armor,” our active duty military personnel need to increase their operational effectiveness and their resiliency in bouncing back from stressful situations. As we move ahead with this more comprehensive approach to health, we can begin to better address so many of our patients for whom we can find no specific reason for pain and discomfort. The PCMH model also provides a positive impact on our costs. Early data reporting from the PCMH clinics at Bethesda show reduced visits to the emergency room, lowered pharmacy costs, and significant per beneficiary per year savings and improved Healthcare Effectiveness Data and Information Set metrics, access, and patient satisfaction and trust. These positive impacts on the bottom line can be applied directly to improved costs or toward the reallocation of resources from reimbursing those who are sick to the population health-based programs that can make and keep our patients healthy.More significant, however, the PCMH environment allows us to go beyond mere collaboration and to a much more proactive approach to managing our patient populations. It is within the context of the medical home that we can begin to surround our patients with the tools and resources they need to move them from health care to health.

Surgeon General of the Navy VADM Matthew L. Nathan, MC USN

Fortunately, we have a way to address this crisis—the
Patient-Centered Medical Home (PCMH) model launched at Naval Hospital Pensacola and Walter Reed National Military Medical Center, Bethesda, Maryland (formerly the National Naval Medical Center) in 2008. It is now being implemented throughout the Military Health System (MHS) and carries great promise. It provides the clinical framework we need to meet our strategic objectives in terms of quality of care, impact on costs, population health, and readiness. One of the most significant benefits of the team-based, collaborative approach is that it allows us to embed within a primary care environment the psychologists, nutritionists, tobacco cessation specialists, mind-body medicine therapists, and health educators our patients need in order to develop and maintain mindful, healthy behaviors—along with the “mental armor,” our active duty military personnel need to increase their operational effectiveness and their resiliency in bouncing back from stressful situations. As we move ahead with this more comprehensive approach to health, we can begin to better address so many of our patients for whom we can find no specific reason for pain and discomfort. The PCMH model also provides a positive impact on our costs. Early data reporting from the PCMH clinics at Bethesda show reduced visits to the emergency room, lowered pharmacy costs, and significant per beneficiary per year savings and improved Healthcare Effectiveness Data and Information Set metrics, access, and patient satisfaction and trust. These positive impacts on the bottom line can be applied directly to improved costs or toward the reallocation of resources from reimbursing those who are sick to the population health-based programs that can make and keep our patients healthy.More significant, however, the PCMH environment allows us to go beyond mere collaboration and to a much more proactive approach to managing our patient populations. It is within the context of the medical home that we can begin to surround our patients with the tools and resources they need to move them from health care to health.

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The Patient-Centered Medical Home in the Transformation From Healthcare to Health

  1. 1. Delivered by Publishing Technology to: Naval Medical Center, San Diego IP: 159.71.254.248 on: Sun, 26 May 2013 21:26:15 Copyright (c) Association of Military Surgeons of the U.S. All rights reserved. IMPACT OF PATIENT-CENTERED MEDICAL HOMES MILITARY MEDICINE, 178, 2:126, 2013 The Patient-Centered Medical Home in the Transformation From Healthcare to Health VADM Matthew L. Nathan, MC USN Our nation’s health and wellness trajectory continues in the wrong direction. Nearly 68% of Americans are overweight or obese. Chronic diseases that account for 75% of all direct health care costs are also on the rise; 45% of the U.S. popula- tion has at least one chronic medical condition, and of those, at least half have multiple chronic conditions. If current trends continue, by the year 2030, these numbers will skyrocket. As a nation, we are on an unsustainable cost trajectory. By 2020, U.S. health care costs are estimated to account for 20% of our gross domestic product. Some of the causes for this are unavoidable, such as aging baby boomers. However, we are not doing enough to combat the entirely preventable causes, namely the trifecta of unhealthy behaviors, including inactiv- ity, poor diet, and tobacco/alcohol use. In addition, there is an increasing tendency for our health care system to prioritize and incentivize taking care of the sick rather than keeping people healthy. Since becoming the Surgeon General of the Navy in November 2011, my priority has been to strategically align Navy Medicine with the priorities of the Secretary of the Navy, Chief of Naval Operations, and Commandant of the Marine Corps. Navy Medicine is fully engaged in executing the operational missions and core capabilities of the Navy and Marine Corps. We do this by maintaining warfighter health readiness, deploying forward, and delivering a contin- uum of care from the battlefield to the bedside, while also protecting the health of all those entrusted to our care. To ensure the fulfillment of our mission, I have outlined 3 stra- tegic goals for the Navy Medicine enterprise: readiness, value, and jointness. Transforming our societal focus from health care (a pound of cure) to health (an ounce of prevention) is a strategic imperative. The implications on military readiness are pro- found. Approximately 30% of potential military candidates ages 17 to 24 do not qualify for military duty because they are overweight; but to sustain our fighting force and successfully execute our missions, our naval forces must be armed with fit, healthy, and ready Sailors and Marines. Fortunately, we have a way to address this crisis—the Patient-Centered Medical Home (PCMH) model launched at Naval Hospital Pensacola and Walter Reed National Military Medical Center, Bethesda, Maryland (formerly the National Naval Medical Center) in 2008. It is now being implemented throughout the Military Health System (MHS) and carries great promise. It provides the clinical framework we need to meet our strategic objectives in terms of quality of care, impact on costs, population health, and readiness. One of the most significant benefits of the team-based, collaborative approach is that it allows us to embed within a primary care environment the psychologists, nutritionists, tobacco cessation specialists, mind-body medicine therapists, and health educators our patients need in order to develop and maintain mindful, healthy behaviors—along with the “mental armor,” our active duty military personnel need to increase their operational effectiveness and their resiliency in bouncing back from stressful situations. As we move ahead with this more comprehensive approach to health, we can begin to better address so many of our patients for whom we can find no specific reason for pain and discomfort. The PCMH model also provides a positive impact on our costs. Early data reporting from the PCMH clinics at Bethesda show reduced visits to the emergency room, lowered pharmacy costs, and significant per beneficiary per year savings and improved Healthcare Effectiveness Data and Information Set metrics, access, and patient satisfaction and trust. These positive impacts on the bottom line can be applied directly to improved costs or toward the reallocation of resources from reimbursing those who are sick to the population health-based programs that can make and keep our patients healthy. More significant, however, the PCMH environment allows us to go beyond mere collaboration and to a much more proactive approach to managing our patient populations. It is within the context of the medical home that we can begin to surround our patients with the tools and resources they need to move them from health care to health. To lead vibrant, Surgeon General of the U.S. Navy Chief, Bureau of Medicine and Surgery, Falls Church, VA. doi: 10.7205/MILMED-D-12-00467 MILITARY MEDICINE, Vol. 178, February 2013126
  2. 2. Delivered by Publishing Technology to: Naval Medical Center, San Diego IP: 159.71.254.248 on: Sun, 26 May 2013 21:26:15 Copyright (c) Association of Military Surgeons of the U.S. All rights reserved. healthy lives, our patients will need health risk assessments, personal plans for health, live and virtual coaching, and access to a broad array of online and mobile applications, including wireless biometric monitoring devices for our sickest patients. We will also need to link our patients to the social networks and community resources that will reinforce their healthy behaviors. None of these objectives come easy. Workforce redevel- opment will play a critical role in our efforts to be successful. Some patients and providers hold on to the comfort of the personal visit for any and all things; however, the reality of our health crisis is that the workflow of the future will be very different. Because our populations are so unhealthy, there will be fewer personal encounters between patients and their providers in favor of phone, e-mail, or web-based visits by nurses, nutritionists, psychologists, coaches, and others who help address the underlying causes of poor health. Our criti- cal reliance on information technology tools is not just out of desire but necessity. Provider appointments will be reserved for only those patients who truly need a provider to hear, see, or touch directly the patient concern. Fortunately, our patients themselves are yearning for a more “plugged-in/ wireless” way to connect to their health providers. There are challenges in implementing the PCMH model. Change is never easy. Conflicting issues over staff roles on a medical home team, competing objectives between teams and leadership, and institutional inertia in the face of innova- tion can all present issues that must be worked through and resolved if the transformation from health care to health is to be successful. Because the PCMH concept is different from the primary care we all grew up with, its unique culture must be fostered, nurtured, and championed, and the lessons learned from its implementation shared MHS wide. The MHS and its population of 9.6 million beneficiaries are positioned uniquely, I believe, to serve as a place where we can pioneer national health care reform efforts. The MHS has the essential ingredients to make this work: an insured population, electronic medical records, potential rewards for health vice health care, and a vertically inte- grated system that “owns” almost all aspects of care. As a closed system that closely mirrors the U.S. population in general, the MHS can allow health care experts and U.S. policymakers to study the effects of the PCMH model; and our population health efforts as tools for a broader, more concerted, national dialogue on how to improve the health of not just a few, but all, Americans. And, I might add, with a sense of urgency. Our choices of unhealthy behaviors as a nation are rapidly closing in not only on our fiscal solvency, but also on our ability to thrive as a healthy nation. Health and access to health care are essential pillars for the well-being of our nation as well. The military engagements that have occupied our efforts for so long may be turning the corner, and our first responsibility will always be to the combat zone; but make no mistake, we must all now deploy to the health care zone. We have no other choice. We need to be healthy, and when danger, disaster, or disease arises, ready. MILITARY MEDICINE, Vol. 178, February 2013 127 Guest Editorial

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