Advancing<br />Patient-Centered <br />Medical Home InnovationMoving from Concept to Practice<br />
What are the major deficiencies in ourcurrent health care delivery system?<br /><ul><li>Is not patient-centered
Does not allocate adequate resources to support prevention and the improvement of health
Does not clearly define patient and provider responsibilities
Is not based on a foundation of partnerships between patients/providers/payors</li></li></ul><li>Deaths that should not oc...
Deaths that should not occur in the presence of effective health care<br />Age-Standardized Death Rates (Per 100,000)<br /...
“Every system is perfectly designed to achieve the results it gets.”<br />Donald Berwick, M.D.<br />Institute for Healthca...
What can be done to address these deficiencies? <br /><ul><li>Transforming our current delivery system will require advanc...
A good place to start transformation at a local level is the advancement of patient-centered medical home (PCMH) innovatio...
What is a patient-centered medical home?<br /><ul><li>The patient‐centered medical home is a model for care provided by ph...
At the core is a physician-directed team committed to coordinating care based on patients’ needs and priorities, communica...
A comparison of then and now…<br />
How will we evaluate improvements?<br />Evaluation of Patient-Centered Medical Homes focused on:<br /><ul><li>Improved acc...
Need primary care organization commitment to transforming their care delivery model
Need patient engagement in managing/improving their own health care</li></li></ul><li>A summary on measuring financial ROI...
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Advancing Patient-Centered Medical Home Innovation

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Advanced primary care models, like patient-centered medical homes, can provide the coordination mechanisms and decision support to improve quality, cost, and satisfaction.

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  • Why do we need to improve care coordination?We all could probably all share our perspectives on why care coordination is important.The commonwealth fund offers the perspective on the screen.Health care services are fragmentedPoor communications contribute to fragmentationOverall we have a poorly performing systemDon Berwick who leads the IHI reminds us that….Every system is perfectly designed to achieve the results it gets….Maybe it is time to redesign what we call our system
  • Why do we need to improve care coordination?We all could probably all share our perspectives on why care coordination is important.The commonwealth fund offers the perspective on the screen.Health care services are fragmentedPoor communications contribute to fragmentationOverall we have a poorly performing systemDon Berwick who leads the IHI reminds us that….Every system is perfectly designed to achieve the results it gets….Maybe it is time to redesign what we call our system
  • A historical perspective – in the 1990’s, managed care was a demand-side strategy developed by plans and employers to decrease inappropriate use of healthcare. Providers found themselves in the role of gatekeeper – not part of their medical training or practice orientation. But – it was a reasonable effort in an attempt to control healthcare costs.Now, PCMH is a supply side strategy developed by plans and providers. Being upstream from the managed care approach, it offers greater potential for improving quality of care and decreasing utilization of high-cost services. Because it is a plan-provider program, employers have been a bit slow to join the effort. Of the published case studies in the PCMH case listing, only two explicitly mention employer involvement – IBM and Roy O Martin Lumber Co in Louisiana.
  • Advancing Patient-Centered Medical Home Innovation

    1. 1. Advancing<br />Patient-Centered <br />Medical Home InnovationMoving from Concept to Practice<br />
    2. 2. What are the major deficiencies in ourcurrent health care delivery system?<br /><ul><li>Is not patient-centered
    3. 3. Does not allocate adequate resources to support prevention and the improvement of health
    4. 4. Does not clearly define patient and provider responsibilities
    5. 5. Is not based on a foundation of partnerships between patients/providers/payors</li></li></ul><li>Deaths that should not occur in the presence of effective health care<br />Age-Standardized Death Rates (Per 100,000)<br />USA<br />Source: Health Affairs, January 2008<br />
    6. 6. Deaths that should not occur in the presence of effective health care<br />Age-Standardized Death Rates (Per 100,000)<br />USA<br />Since we spend more than anyone else….<br />Should we expect more value?<br />USA in last place on this quality measure<br />Source: Health Affairs, January 2008<br />
    7. 7.
    8. 8. “Every system is perfectly designed to achieve the results it gets.”<br />Donald Berwick, M.D.<br />Institute for Healthcare Improvement (IHI)<br />
    9. 9. What can be done to address these deficiencies? <br /><ul><li>Transforming our current delivery system will require advancing patient-centered health care to optimize individual health
    10. 10. A good place to start transformation at a local level is the advancement of patient-centered medical home (PCMH) innovation.</li></li></ul><li>The current primary care system must be transformed to address current issues <br />Advanced primary care models, like patient-centered medical homes, can provide the coordination mechanisms and decision support to improve quality, cost, and satisfaction<br />Current challenges confronting primary care<br />Emergency room visits increased by 36% between 1996 and 2006; 47% of ED visits could have occurred in a physician’s office<br />20% of patients are readmitted within 30 days of hospitalization, most of which are avoidable<br />50% of patients that are readmitted do not see a physician after their first hospitalization<br />75% of health care spending is for patients with chronic diseases<br />Over two years, the typical Medicare patient sees 2 different primary care doctors and 5 different specialists<br />Millions of additional Americans will enter the primary care system with health reform<br />
    11. 11. What is a patient-centered medical home?<br /><ul><li>The patient‐centered medical home is a model for care provided by physician practices that seeks to strengthen the physician‐patient relationship by replacing episodic care based on illnesses and patient complaints with coordinated care and a long‐term healing relationship.
    12. 12. At the core is a physician-directed team committed to coordinating care based on patients’ needs and priorities, communicating directly with patients and their families, and integrating care across settings and practitioners. </li></li></ul><li>What is a patient-centered medical home?<br />
    13. 13. A comparison of then and now…<br />
    14. 14. How will we evaluate improvements?<br />Evaluation of Patient-Centered Medical Homes focused on:<br /><ul><li>Improved access to care</li></ul>- Be immediately accessible for patient concerns<br />- Promptly treat acute illness<br />- Create new opportunities to provide preventive care and chronic disease management<br /><ul><li>Controlling health care costs</li></ul>- Prevent needless emergency department visits<br />- Intervene early to reduce hospitalizations<br /><ul><li>Patient Engagement- Do patients value care coordination? - Do patients value patient-centered approach?</li></li></ul><li>What will be required to sustain the transformation?<br /><ul><li>Health plan and employer commitment to the transformational change
    15. 15. Need primary care organization commitment to transforming their care delivery model
    16. 16. Need patient engagement in managing/improving their own health care</li></li></ul><li>A summary on measuring financial ROI?<br />
    17. 17. A summary on measuring financial ROI?<br />Investment in Patient-Centered Medical Home Model has potential for break-even return (or better) in year 1!<br />
    18. 18. Introduction to Patient-Centered Medical Home<br />Click below to watch a brief 5 minute overview:<br />http://www.pcpcc.net/content/emmi<br />

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