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Presentation by Sheila Richmeier
- 1. 6/8/2011 Patient Centered Medical Home What Does it Mean? Lawrence Medical Managers meeting June 2011 Sheila Richmeier, MS, RN, FACMPE Declining value of primary care Primary care is in trouble. . . . • Overwhelming amount of work • Poor compensation • Pipeline is drying up • Aging and sicker population • Health care costs skyrocketing • Quality and coordination lag • Physician frustration 2010 TransforMED 1
- 2. 6/8/2011 Aging and sicker population •52% of the American population has a chronic medical condition •Number of older people is projected to rise from 31.6 to 65 million from 1990 to 2030 •Lifestyles are having an impact on health like never before •2/3 of elderly are overweight or obese •Obesity rates have doubled • since mid-80s alone AHRQ Chronic Care Rising costs • 52% of US population has a chronic disease • Individuals with chronic illness account for 80% of health care spending ▫ 75% of every dollar ▫ 83% of every Medicaid dollar ▫ 99% of every Medicare dollar • Life style is having an impact on health ▫ 2/3 of elderly are overweight or obese ▫ Obesity rates have doubled since mid-80s ▫ Obesity is responsible for 1/3 of the growth of health care spending Hitting the “Bulls-eye” in Health Reform • Increasing Prevalence of Chronic Conditions and Increasing Costs Prevalence of Chronic Conditions Cost of Specific Chronic Conditions Chronic Condition Prevalence Annual Cost 180 49% Cardiovascular Disease 80 million $475.3 billion (includes both 170 48% direct and indirect costs) 160 157 Diabetes 23.6 million $116 billion of direct healthcare 47% costs 149 150 $58 billion in indirect costs/ lost 141 46% productivity 140 133 45% 125 Asthma ~20 million $18.3 billion, including direct 130 healthcare costs (10.1 billion) 118 44% and indirect costs/ lost 120 productivity (8.2 billion) 43% 110 Depression 20.9 million ~$100 billion of direct healthcare 100 42% costs (across all mental illnesses) 90 41% ~$79 billion in indirect costs/ lost productivity (across all mental 80 40% illnesses) 1995 2000 2005 2010 2015 2020 2010 TransforMED 2
- 3. 6/8/2011 Frustration Value of primarycare • Easily accessible first contact with the health care system • Comprehensive care for all health related situations regardless of age or sex • Coordination and integration of care across settings • Personal relationships over time through partnerships in the context of family and community 9 Easily accessible • Time • Availability ▫ Office hours ▫ Language barriers ▫ Same day access ▫ Transportation • Location problems • Delivery ▫ In person ▫ On phone ▫ Interactive websites 3
- 4. 6/8/2011 Timely access Percent reporting that it is very difficult/difficult: 30 73% of Americans report having difficulty in obtaining timely access 41 to their doctor 60 73 0 25 50 75 100 Source: Commonwealth Fund Survey of Public Views of the U.S. Health Care System, 2008. 11 11 After hours care without ER visit Percent reported very/somewhat difficult getting care on nights, weekends, or holidays without going to ER* 100 75 65 68 59 63 63 57 50 45 43 38 38 33 25 0 AUS CAN FR GER NETH NZ NOR SWE SWIZ UK US * Base: Needed care and answered question. Source: 2010 Commonwealth Fund International Health Policy Survey in Eleven Countries. 2010 TransforMED 12 Emergency Room Use in Past Two Years Percent Any ER use Used ER for condition treatable by regular doctor, if available 75 50 44 35 37 33 27 29 26 26 25 25 22 22 16 15 10 10 8 12 7 9 7 5 5 0 TH NZ N R R H NZ N R FR R S UK E FR S IZ UK US E IZ US SW GE T SW AU CA GE NO AU CA NO SW SW NE NE Source: 2010 Commonwealth Fund International Health Policy Survey in Eleven Countries. 2010 TransforMED 4
- 5. 6/8/2011 Growth of Retail Clinics, Year End 2005–2007 Number of retail clinics 900 1000 800 30 states 23 states Dec. 07 800 Dec. 06 600 400 200 60 18 states Dec. 05 0 2005 2006 2007 Source: Interview with Mary Kate Scott, principal of Scott & Company, July 2008. % 80 Retail clinic choices 64 62 60 53 48 40 34 20 0 Clinic hours Location Did not have Cost was Did not have were more was more to make an lower than a usual convenient convenient appointment another source of care than another than another for a source of care source of care source of care retail clinic Notes: Categories are not mutually exclusive; respondents were able to select multiple categories. Source: Center for Studying Health System Change 2007 Health Tracking Household Survey, April 2007–January 2008. Traditional Model New Model • Unnecessary barriers to access • Same or next day access by by patient patients • Monday through Friday • After hours and weekend care 9–5 • Alternate means of • In person visit only communication • Primary care physician could ▫ Interactive website not see you ▫ Phone triage and follow-up • Same physician or team sees you every time • Alternate visit types ▫ Group visits ▫ e-visits 5
- 6. 6/8/2011 16 Comprehensive • Whole person care • Quality versus • Population quantity management ▫ Preventive ▫ Chronic disease management • Non-differentiated care • Often birth to death • Evidence based Traditional Model New Model • Event – based medicine • Continuous healthcare • Experience based • Quality improvement ▫ Docs with the most experience are the best ▫ Patient experience survey docs ▫ Provider satisfaction survey ▫ Employee satisfaction survey ▫ Clinical outcome measurement ▫ Financial outcome measurement ▫ Study and planning of results • Evidence based ▫ Evidence based guidelines ▫ Clinical outcomes reported Traditional Model New Model • Reactive management of • Pro-active population patients’ preventive and management for chronic and chronic care preventive care ▫ Patient makes appointment ▫ Anticipate needs of patients when needed prior to visit ▫ Acute chronic is managed in ▫ Pre-visit planning hospital setting ▫ Management of high acuity ▫ High acuity patients are patients more intensely known as “frequent flyers” ▫ Overall better management of chronics 6
- 7. 6/8/2011 19 Coordination of care • Emphasis on • Tracking & follow-up communication ▫ Referral tracking ▫ With patient /family ▫ Test tracking ▫ Across settings • Medical neighborhood • Facilitate transitions ▫ Information ▫ Accountability • Community resources ▫ Home health ▫ Nursing homes ▫ Health departments 2010 TransforMED Medicare re-hospitalization rates JAMA 7
- 8. 6/8/2011 Traditional Model New Model • Proactive transitions of care • Reactive coordination of care between hospitals and primary • Referral specialists taking care over care ▫ Patients are pro-actively • Patient goes to specialists as called after hospitalization needed • Agreement on roles & responsibilities between specialists and primary care • Referral and test tracking • PCP coordinates all care outside office 23 Relationship • Personal physician • Continuity ▫ Increased efficiency • Team assigned to care ▫ Better quality • Long term • Communication ▫ For patient engagement ▫ For patient education 8
- 9. 6/8/2011 Traditional Model New Model • Physician is the main • Multidisciplinary team is source for care the source of care ▫ Each member participates in the care ▫ Each member has a role ▫ All members understand each others’ roles Traditional Model New Model • Patient engagement • Communication as ▫ Giving test result needed with patients – numbers sharing only need to ▫ Giving patients know information information resources • Directive communication ▫ Knowledge by patient about internal and external team members • Collaboration ▫ Patients receive care plan at each visit ▫ Patient is part of care team helping to make decisions about care Goals in running a medical home -- • Good quality outcomes • Good financial outcomes • Good satisfaction outcomes 2010 TransforMED 9
- 10. 6/8/2011 Satisfaction outcomes • Happy docs • Happy staff • Happy patients Medical home concepts - Access, patient centered care, team based care 2010 TransforMED Financial outcomes Internal Health care system • Salaries • Hospitalization • Revenues • Re-hospitalizations • Profit margin • Use of generic drugs • Bonuses • Complications in • Cost of unit of service surgery • ER utilization Medical home concepts - Care coordination, access, sound practice management, health information technology Quality outcomes Chronic disease Population management management • Disease specific • Preventive medicine ▫ Diabetes ▫ Cancer screening ▫ Hypertension ▫ Immunizations ▫ Coronary heart • High risk behaviors disease ▫ Obesity • High users of the system ▫ Smoking ▫ Child safety Medical home concepts - Care management, health information technology, care coordination 10
- 11. 6/8/2011 32 What comes first? Where is medical home? • PCMH demonstrations rollout in every state except Alaska. • Medicare Advanced Primary Care demonstration. • Federal departments and agencies establish PCMH as the foundation for national transformations: ▫ Department of Defense ▫ Department of Veterans’ Affairs ▫ HRSA 2010 TransforMED 11
- 12. 6/8/2011 2010 TransforMED Get started. . . . "In order to succeed, your desire for success should be greater than your fear of failure.“ -- Bill Cosby "The problem in my life and other people's lives is not the absence of knowing what to do, but the absence of doing it.” -- Peter Drucker 2010 TransforMED Questions Sheila Richmeier, MS, RN, FACMPE sheila@remedyhc.com Remedy Healthcare Consulting www.RemedyHealthcareConsulting.com 12