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Onc july atlanta 2011

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Ohio may 14 2011
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Onc july atlanta 2011

  1. 1. ONC and PCMH 2011<br />Paul Grundy, MD, MPH, FACOEM, FACPM IBM Director Healthcare TransformationPresident Patient Centered Primary Care Collaborative<br />Paul Grundy MD, MPH <br />IBM International Director Healthcare Transformation<br />Trip to Denmark July 10 2009 <br />
  2. 2. Reinventing Medicaid findings are Outstanding<br />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. <br />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. <br />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.  <br />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. <br />The Bottom Line in Medicaid <br />PCMH starting to show an impact in access to care, quality, and cost control.<br />Citation -- M. Takach, "Reinventing Medicaid: State Innovations to Qualify and Pay for Patient-Centered Medical Homes<br /> Show Promising Results," Health Affairs, July 2011 30(7):1325–34. <br />
  3. 3. Out in July 2011 <br />BCBS MA 6% decrees cost (NEJM) <br />BCBS Mi 2670 physician (BIG study)<br />
  4. 4. MGMA: 70% of Practices at Least Interested in Becoming Patient Centered Medical Homes<br />13 to 20 % are already on the road <br />Some states Michigan, Minnesota, Maryland, RI, VT 50% already are well on the road !! <br />Standard of care in the VA, DOD<br />IBM $ 60 per Member BCBS HI 14.6% <br />^<br />
  5. 5. Outside Hospital video clip <br />
  6. 6. Who was the <br />Shooter’s Doctor? <br />Population management<br />Accountability <br />
  7. 7. Why Innovate Affordability<br />$30,000<br />+166%<br />$25,000<br />$20,000<br />$15,000<br />+118%<br />$10,000<br />$4,918<br />$5,000<br />$0<br />2001<br />2009<br />2019<br /> - Employee Payroll Contributions<br />- Employer Cost<br />- Employee Out of Pocket Expenses<br />a<br />The Elephant in the room<br />$28,530<br />Costs continue their upward climb…<br />…with employers still picking up much of the tab…<br />$10,743<br />
  8. 8. Health care is a business issue, not a benefits issue<br />
  9. 9. 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!!”<br />You the AHC’s - Unaccountable Care Organizations PART of this problem <br />* Peter A. Muennig and Sherry A. Glied Health Affairs Oct. 7, 2010<br />
  10. 10. Don’t handle your care needs in a BAD MEDICAL NEIGHBORHOOD!!<br />Unaccountable care, lack of organization, DO NOT GO THERE ALONE !! <br />Be wise when you pay for care, KNOW WHAT YOU BUY!!<br />
  11. 11. Coordination -- we do NOT know how to play as a team<br />“ 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<br />
  12. 12. “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.”<br /> George Halvorson (CEO Kaiser) from “Healthcare Reform Now”<br />
  13. 13. The Diabetic needs A long-term comprehensive relationship with a Personal Physician empowered with the right tools and linked to their care team. <br />
  14. 14. The Joint Principles: Patient Centered Medical Home<br /><ul><li>Personal physician - each patient has an ongoing relationship with a personal physiciantrained to provide first contact, and continuous and comprehensive care
  15. 15. 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
  16. 16. 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
  17. 17. Care is coordinated and integrated across all elements of the complex healthcare community- coordination is enabled by registries, information technology, and health information exchanges
  18. 18. Quality and safety are hallmarks of the medical home- </li></ul> Evidence-based medicine and clinical decision-support tools guide decision-making; Physicians in the practice accept accountability voluntary engagement in performance measurement and improvement<br />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 <br /><ul><li>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 </li></ul>14<br />
  19. 19. The Quadruple AimReadiness, Experience of Care, Population Health, Cost<br />Per Capita Cost<br />Population<br />Health<br />The System Integrator <br />Creates a partnership across the medical neighborhood <br />Drives PCMH primary care redesign<br />Offers a utility for population health and financial management<br />System Integrator<br />Patient<br />Experience<br />Productivity <br />
  20. 20. <ul><li>For Diabetes you need a Captain for the ship
  21. 21. You need a place of command and control
  22. 22. You need a horizontal platform from which to launch vertical weapon systems
  23. 23. You need somewhere and someone to hold accountable</li></li></ul><li>If you scan the world for value based healthcare, you will find a common element: a relationship-based team with a project manager!<br />A comprehensivist that can command and control in an accountable system. <br />So simple!<br />So much!<br />
  24. 24. Team-Based <br />HealthcareDelivery<br />Population<br />Health <br />Access to Care<br />Patient<br />is the centerof theMedical Home<br />Advanced IT Systems<br />Patient-Centered Care<br />Decision Support Tools<br />Refocused Medical Training<br />Patient & Physician Feedback<br />Enhancing Health and the Patient Experience<br />Medical Home Model<br />Model adapted from theNNMC Medical Home<br />
  25. 25. Defining the Care Centered on Patient <br />Superb Access to Care<br />Team Care<br />Patient Engagement in Care<br />Patient Feedback<br />Clinical Information Systems<br />Publically Available Information<br />Care Coordination<br />
  26. 26. Smarter Healthcare…<br />36.3% Drop in hospital days<br />32.2% Drop in ER use <br />9.6% Total cost <br />10.5% Inpatient specialty care costs are down<br />18.9% Ancillary costs down <br />15.0% Outpatient specialty down<br />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 <br />
  27. 27. 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. <br />Ref Health Affairs 7 July 2011 .<br />
  28. 28. OPM $39 Billion Book with Accountable Care<br />Patient at the center<br /><ul><li>24-7 clinician phone response
  29. 29. Provide open scheduling.
  30. 30. Provide care management and coordination by specially-trained team members.
  31. 31. Use an EHR with decision support.
  32. 32. Use CPOE for all orders, test tracking, and follow-up.
  33. 33. Medication reconciliation for every visit.
  34. 34. Prescription drug decision support.
  35. 35. Implement e-prescribing.
  36. 36. Pre-visit planning and after-visit follow-up for care management.
  37. 37. Offer patient self-management support.
  38. 38. Provide a visit summary to the patient following each visit.
  39. 39. Maintain a summary-of-care record for patient transitions.
  40. 40. Email consultations.
  41. 41. Telephone consultations.
  42. 42. The development of care plans.
  43. 43. Performance outcome </li></ul> measures.<br />
  44. 44. PCMH in Action <br />Vermont “Blueprint” model <br />A Coordinated <br />Health System<br />Hospitals<br />Community Care Team<br />Nurse Coordinator<br />Social Workers<br />Dieticians<br />Community Health Workers<br />Care Coordinators<br />Public Health Prevention<br />HEALTH WELLNESS<br />PCMH<br />Health IT <br />Framework<br />Specialists<br />Global Information Framework<br />PCMH<br />Evaluation <br />Framework<br />Public Health Prevention<br />Operations<br />
  45. 45. Vermont Financial Impact<br />Vermont Financial Impact<br />
  46. 46. Payment reform requires more than one method, you have dials, adjust them!!!<br />fee for health”<br />“fee for outcome”<br />“fee for process”<br />“fee for belonging<br />“fee for service” <br />“fee for satisfaction”<br />
  47. 47. Reinventing Medicaid: State PCMH Innovations Show Promising Results New Payment Incentives – 17 states evaluated <br />Monthly care management fees. Most of the states studied pay patient-centered medical homes a per-member per-month fee averaging about $3 to $6. PAY FOR HIT Meaningful USE<br />Enhanced fee-for-service payments. Medicaid strategy rewards "well care" more highly than "sick care." <br />Network payments. North Carolina and Vermont pay networks or teams to support patient-centered medical homes. <br />Pay-for-performance. Nebraska, Oklahoma, and Pennsylvania are using performance-based payments. to complement other payments to patient-centered medical homes. Pennsylvania practices that have met certain performance criteria can share in any savings they generate.<br />Medicaid plans and commercial insurers. Seventeen states are participating or plan to participate in multipayer patient-centered medical home initiatives. Eight will add Medicare as a payer in 2011 <br />Citation -- M. Takach, "Reinventing Medicaid: State Innovations to Qualify and Pay for Patient-Centered Medical Homes<br /> Show Promising Results," Health Affairs, July 2011 30(7):1325–34. <br />
  48. 48. Care Coordination Payments To Practices In State Patient-Centered Medical Home Initiatives<br /><ul><li>SOURCE Author’s analysis of state government information. NOTES The </li></li></ul><li>28<br />
  49. 49. PCMH is non-political – the right POV for delivery transformation <br />“We never abandoned advocating new<br />Models of care. We’ve long pushed folks<br />to realize that Delivery reform is the key.”<br />The patient-centered medical home is<br />core.<br />“We included the attached chapter on PCMH in our book. and have a new publication on ACOs coming out in January.”<br />
  50. 50. OR? <br />…Requires a Smarter Healthcare Workforce<br />Where do you train the Workforce? <br />
  51. 51.
  52. 52. Analytics Maturity Landscape<br />Communication & Culture<br />Breakaway<br />Analytics embraced & integrated into every day decisions & operations<br />Passionate sponsor of analytics<br />Test and Learn<br />Culture<br />Intelligent<br />Operational buy-in to performance analysis driving decisions<br />Robust feedback loop<br />Advanced Analytics<br />Monitoring, Prediction, Action<br />Automated analysis/alert<br />Performance messages widely communicated<br />Performance Metrics<br />Leverage cross- departmental & functional data to derive actionable insight<br />Predictive modeling<br />Single version of truth<br />Integrated information <br />Descriptive Analytics<br />Adaptive Machine Learning<br />Contextual business rules<br />Collaboration & workflow tools to aid planning & info sharing<br />Data warehouses, governance and production reporting<br />Pride in the gut based decision<br />Basic<br />Leverage structured & unstructured data for decision making<br />Real-Time Decision Support<br />Personalized & role based portal<br />Spreadsheets<br />Isolated reporting & analysis systems<br />Significant manual input<br />
  53. 53. Patients love to see meaningful information about themselves and it take IT tools to <br /> If you give patients educational materials with their name on it and with their data analyzed in it, they will read it, pour over it and discuss it with you. <br /> If you tear off a generic sheet and give it to them, it often goes in the waste basket. If you give patients an analysis of their health risk AND if you include a “what if” scenario, i.e., what will their health risk be if they make a change; you can prove to them,<br /> “if you the healer make a change, it will make a difference to your patient.”<br />
  54. 54. Recommendations<br /><ul><li>Build the foundation, the horizontal platform, a place of accountability – PCMH that allows HIT to be paid for.
  55. 55. Really engage your patients find out what they need and become very patient centered
  56. 56. Integrate value base purchasing with PCMH in your plan designee (understand what the buyer wants)
  57. 57. Stop teaching the past you are in a world of Data, teams, actionable information
  58. 58. Integrate Health and Sick care
  59. 59. GIVE US LEADERSHIP - SHOW US THE WAY!</li></li></ul><li>35<br />
  60. 60. I) if quality care exists in your community, use it<br />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. <br />3) Seek out and use “Patient Centered Medical Homes” for health care<br />4) Find physicians who are trying to conquered the digital divide<br />5) Find a doctor comfortable with moving into the future with data, populating management, <br />6) Demand a focus on quality<br />7) Demand provides in your community to collaborate, collaborate, collaborate<br />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<br />8) Encourage mental health and primary care to work together (the Brain is connected to the body) <br />9) Work to build a healthy community integrate health and sick care<br />