Patient Centered Medical Home             Paul Grundy MD, MPH    IBM‘s Director Healthcare Transformation                N...
Away from Episode of Care            to Management of Population                                   Population        Per  ...
Smarter Healthcare36.3% Drop in hospital days32.2% Drop in ER use12.8% Increase Chronic Medication use-15.6%        Total ...
“We do the best               heart surgeries.”“How to Stop Hospitals From Killing Us” WSJ - 21 Sept 2012“Bitter pill: The...
WellPoint PCMH Preliminary Year 2 Highlights In Sept                     Issue Health affairs 2012                 •   18%...
Practice transformation away from episode of care        Preventive      Chronic Disease       Medication         Medicine...
Healthcare will Transform  • Data Driven  • Every patient has a plan  • Team based
Defining the Care Centered on Patient        Superb Access        to Care               Team Care        Patient Engagemen...
Payment reform requires more than one method, you             have dials, adjust them!!!   “fee for health”    fee for val...
Benefit Redesign - Patient Engagement Different Strategies forDifferent Healthcare Spend Segments                         ...
PCMH in Action                                               A Coordinated                                               H...
Why the Medical Home Works: A Framework   Feature                   Definition                               Sample Strate...
Whsrma 2013   grundy singapore april 2013
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Whsrma 2013 grundy singapore april 2013

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World Health Summit Singapore April 2013

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Whsrma 2013 grundy singapore april 2013

  1. 1. Patient Centered Medical Home Paul Grundy MD, MPH IBM‘s Director Healthcare Transformation New York, USA Pgrundy@us.ibm.com
  2. 2. Away from Episode of Care to Management of Population Population Per Health Capita Cost System Integrator Patient Productivity Experience The System Integrator Creates a partnership across the medical neighborhoodDrives PCMH primary care redesignOffers a utility for population health and financial management
  3. 3. Smarter Healthcare36.3% Drop in hospital days32.2% Drop in ER use12.8% Increase Chronic Medication use-15.6% Total cost10.5% Inpatient specialty care costs down18.9% Ancillary costs down15.0% Outpatient specialty downOutcomes of Implementing Patient Centered MedicalHome Interventions: A Review of the Evidence fromProspective Evaluation Studies in the US - PCPCC Oct 2012
  4. 4. “We do the best heart surgeries.”“How to Stop Hospitals From Killing Us” WSJ - 21 Sept 2012“Bitter pill: The cost of health care” - Time - 23 Feb 2013
  5. 5. WellPoint PCMH Preliminary Year 2 Highlights In Sept Issue Health affairs 2012 • 18% decrease in acute IP admissions/1000, compared to 18% increase in control group Colorado • 15% decrease in total ER visits/1000, compared to 4% increase in control group • Specialty visits/1000 remained around flat compared to 10% increase in control group NEW HAMPSHIRE • Overall Return on Investment estimates ranged between 2.5:1 and 4.5:1 New York
  6. 6. Practice transformation away from episode of care Preventive Chronic Disease Medication Medicine Monitoring Refills Acute Care Test Results DOCTOR Case Behavioral MedicalMaster Builder Manager Health Assistants Nursing Source: Southcentral Foundation, Anchorage AK
  7. 7. Healthcare will Transform • Data Driven • Every patient has a plan • Team based
  8. 8. Defining the Care Centered on Patient Superb Access to Care Team Care Patient Engagement in Care Patient Feedback Clinical Information Systems, Registry Publicly Available Information Care Coordination
  9. 9. 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”
  10. 10. Benefit Redesign - Patient Engagement Different Strategies forDifferent Healthcare Spend Segments Those with severe, acute illness or injuries Those with % Total chronic illness Healthcare Those who are well or think they are well Spend % of Members 11 11
  11. 11. PCMH in Action A Coordinated Health System Hospitals Community Care Team Health IT Nurse Coordinator Framework PCMH Social Workers Dieticians Global Information Community Health Workers FrameworkSpecialists Care Coordinators Evaluation PCMH Public Health Prevention Framework HEALTH WELLNESSPublic Health Operations Prevention Copyright 2011 by IBM 35
  12. 12. Why the Medical Home Works: A Framework Feature Definition Sample Strategies Potential Impacts Supports patients in learning to • Additional staff positions to help patients navigate manage and organize their own care the system and fulfill care plans (e.g., care Patients are more likely to seek at the level they choose, and ensures coordinators, patient navigators, social workers) the right care, in the right place,Patient-Centered that patients and families are fully • Compassionate and culturally sensitive care and at the right time. informed partners in health system • Strong, trusting relationships with physicians and transformation at the practice, care team, and open communication about community, and policy levels. decisions and health status • Care team focuses on ‘whole person’ and Patients are less likely to seek care A team of care providers is wholly from the emergency room or population health accountable for a patient’s physicalComprehensive and mental health care needs, • Primary care is co-located with oral, vision, hospital, and delay or leave OB/GYN, pharmacy and other services conditions untreated including prevention and wellness, • Special attention paid to chronic disease and acute care, and chronic care. complex patients Providers are less likely to order • Care is documented and communicated effectively duplicate tests, labs, or Ensures that care is organized across across providers and institutions, including all elements of the broader health procedures patients, primary care, specialists, hospitals, home Coordinated care system, including specialty care, health, etc. hospitals, home health care, and • Communication and connectedness is enhanced by community services and supports. health information technology Better management of chronic diseases and other illness improves health outcomes Delivers consumer-friendly services • Implement more efficient appointment systems with shorter wait-times, extended that offer same-day or 24/7 access to care team Accessible hours, 24/7 electronic or telephone • Use of e-communications and telemedicine to access, and strong communication provide alternatives for face-to-face visits and Focus on wellness and prevention through health IT innovations. allow for after hours care. reduces incidence / severity of chronic disease and illness • Use electronic health records and clinical decision Demonstrates commitment to quality Committed to improvement through the use of support to improve medication management, treatment, and diagnosis. quality and health IT and other tools to ensure • Establish quality improvement goals to maximize Health care dollars saved from that patients and families make reductions in use of ER, hospital, safety informed decisions about their health. data and reporting about patient populations and test, procedure, & prescriptions. monitor outcomes

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