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THE PATIENT-CENTERED MEDICAL HOME (PC-MH):

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THE PATIENT-CENTERED MEDICAL HOME (PC-MH):

  1. 1. THE PATIENT-CENTERED MEDICAL HOME (PC-MH): WHAT IS IT, WHY IS IT IMPORTANT, and WHO CARES? STEVEN A. CRAWFORD, M.D. 2007 CHAIR, AAFP COMMISSION ON GOVERNMENTAL ADVOCACY PROFESSOR & CHAIR OU COLLEGE OF MEDICINE DEPARTMENT OF FAMILY & PREVENTIVE MEDICINE
  2. 2. Hamster Health Care Joseph E. Scherger, MD, MPH; ICSI/IHI Colloquium, May 18, 2007
  3. 3. Hamster Health Care <ul><li>“ Across the globe doctors are miserable because they feel like hamsters on a treadmill. They must run faster just to stand still…. The result of the wheel going faster is not only a reduction in the quality of care but also a reduction in professional satisfaction and burnout among doctors.” </li></ul>Ian Morrison & Richard Smith. BMJ. 2000;321:1541-1542
  4. 4. Introduction <ul><li>WHAT IS THE PC-MH? </li></ul><ul><li>WHY IS IT IMPORTANT? </li></ul><ul><li>WHO CARES? </li></ul><ul><li>NEXT STEPS? </li></ul>
  5. 5. What is a PC-MH? <ul><li>A PC-MH is a proposal by primary care physicians to organize care based on the Institute of Medicine’s definition of patient-centered care: </li></ul><ul><li>“ providing care that is respectful of and responsive to individual patient preferences, needs, values and ensuring that patient values guide all clinical decisions” </li></ul>Institute of Medicine, Crossing the Quality Chasm: A New Health System for the 21 st century, March 2001; Presentation to the Patient-Centered Primary Care Collaborative: Call-to-Action Summit; Bob Doherty, SVP, Governmental Affairs and Public Policy American College of Physicians
  6. 6. What is a PC-MH? <ul><li>CORE FEATURES OF A MEDICAL HOME </li></ul><ul><li>Personal Physician </li></ul><ul><li>Physician Directed Medical Practice </li></ul><ul><li>Whole Person Orientation </li></ul><ul><li>Care is Coordinated and/or Integrated </li></ul><ul><li>Quality and Safety </li></ul><ul><li>Enhanced Access </li></ul><ul><li>Payment Reform </li></ul>Joint Principles of the patient-centered medical home. www.medical-homeinfo.org/Joint%20Statement.pdf 10-24-07
  7. 7. WHY IS IT IMPORTANT? <ul><li>In the U.S., PCP supply is consistently associated with improved health outcomes for conditions like cancer, heart disease, stroke, infant mortality, low birth weight, life expectancy, and self-rated care. </li></ul><ul><li>In England, each additional PCP per 10,000 persons is associated with an approximate decrease in mortality of 6%. </li></ul><ul><li>In the U.K., an increase in PCP’s resulted in a significant decrease in both acute and chronic hospital admissions. </li></ul>Starfield B. Shi L, and Macinko J. Contributions of Primary Care to Health Systems and Health, Millbank Quarterly, Vol. 83, No. 3, 2005 (457-502)
  8. 8. WHY IS IT IMPORTANT? <ul><li>U.S. adults who reported having a PCP rather than a specialist as their regular source of care had lower 5 year mortality rates after controlling for initial differences in health status, demographics, health insurance status, health perceptions, reported diagnosis, and smoking status. </li></ul>Starfield B. Shi L, and Macinko J. Contributions of Primary Care to Health Systems and Health, Millbank Quarterly, Vol. 83, No. 3, 2005 (457-502)
  9. 9. WHY IS IT IMPORTANT? <ul><li>Patients who use a particular doctor for their care have more preventive care, more accurate diagnosis, fewer diagnostic tests, fewer prescriptions, fewer ER visits, and fewer hospitalizations, resulting in lower cost of care. </li></ul>Starfield B. Shi L, and Macinko J. Contributions of Primary Care to Health Systems and Health, Millbank Quarterly, Vol. 83, No. 3, 2005 (457-502)
  10. 10. WHY IS IT IMPORTANT? <ul><li>In the U.S., when adults have a medical home, access to needed care, receipt of routine preventive screenings, and management of chronic conditions improve substantially. </li></ul>A. C. Beal, M. M. Doty, S. E. Hernandez, K. K. Shea, and K. Davis, Closing the Divide: How Medical Homes Promote Equity in Health Care: Results From The Commonwealth Fund 2006 Health Care Quality Survey , The Commonwealth Fund, June 2007
  11. 11. WHY IS IT IMPORTANT? <ul><li>North Carolina Medicaid enrolls recipients in a network of physician-directed medical homes </li></ul><ul><li>External accounting suggests that North Carolina Medicaid saved $231 million over what would have been spent otherwise in 2005 and 2006 </li></ul><ul><li>Mercer Cost Effectiveness Analysis – AFDC only for Inpatient, Outpatient, ED, Physician Services, Pharmacy, Administrative Costs, Other). From presentation by Dobson, Al, Patient-Centered Primary Care Roundtable, March 12, 2007 </li></ul>
  12. 12. WHY IS IT IMPORTANT? <ul><li>Denmark </li></ul><ul><li>Organizes its entire health care system around PC-MH </li></ul><ul><li>Achieve the highest patient satisfaction ratings in the world </li></ul><ul><li>PCP’s are highly accessible & supported by an outstanding IT system that assists in coordinating care </li></ul><ul><li>Among the lowest per capita health expenditures & highest primary care rankings for Western nations </li></ul>K. Davis, Learning From High Performance Health Systems Around the Globe, Invited Testimony: Senate Health, Education, Labor, and Pensions Committee Hearing &quot;Health Care for All Americans: Challenges and Opportunities,&quot; January 10, 2007
  13. 13. WHO CARES? <ul><li>Consumers – YOU!! </li></ul><ul><li>Business Community </li></ul><ul><li>Provider Community </li></ul><ul><li>Payors </li></ul><ul><li>Advocacy Groups </li></ul>
  14. 14. WHO CARES? <ul><li>Endorsed by… </li></ul><ul><ul><li>The AAP, AAFP, ACP, and AOA, representing approximately 333,000 physicians, publishes joint principles to describe the core features of the PC-MH </li></ul></ul><ul><ul><li>The Patient-Centered Primary Care Collaborative, representing employers, physicians, consumers and health plans </li></ul></ul>
  15. 15. WHO CARES? <ul><li>AARP </li></ul><ul><li>Bridges To Excellence </li></ul><ul><li>The ERISA Industry Committee </li></ul><ul><li>Exelon Corp </li></ul><ul><li>General Motors </li></ul><ul><li>IBM </li></ul><ul><li>McKesson Corporation </li></ul><ul><li>National Association of Community Health Centers </li></ul><ul><li>National Business Group on Health </li></ul><ul><li>National Business Coalition on Health Care </li></ul><ul><li>National Committee for Quality Assurance </li></ul><ul><li>National Retail Federation </li></ul>
  16. 16. NEXT STEPS? <ul><li>Agree on a definitive statement of a PC – MH proposal </li></ul><ul><li>Conduct education process </li></ul><ul><li>Buy-in by important players </li></ul><ul><li>Align system incentives for behavior with desired goals </li></ul><ul><li>Develop a system of documentation, accountability, transparency, and continuous-quality improvement </li></ul>
  17. 17. NCQA Scoring for PC-MH
  18. 18. <ul><li>Questions? </li></ul><ul><li>Patient-Centered Primary Care Collaborative: </li></ul><ul><li>www.pcpcc.net/ </li></ul>

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