The document discusses several topics:
1. A new set of criteria has been developed by NCQA and PCPCC to recognize physician practices as patient-centered medical homes based on 7 principles.
2. Matria has partnered with Microsoft to support HealthVault, a new health platform that allows users to store and access personal health information online.
3. A case study describes how Matria client BD integrated disability management with disease management, increasing participation in health programs from 23% to 48%.
Partnering with Patients, Families and Communities for Health: A Global Imper...EngagingPatients
Engagement is an essential tool to improving global health. This report introduces a new framework for engagement to help countries assess current programs and think strategically about future engagement opportunities. It spotlights barriers to engagement and offers concrete examples of effective engagement from around the globe.
Patient Centered Medical home talk at WVUPaul Grundy
To employers the cost of healthcare is now a business issue and this talk is about what one large buyer IBM did to drive transformation via broad coalition with other large employers to form the Patient Centered Medical Home movement and the covenant between buyer and provider away from the garbage we now buy episodic uncoordinated disintegrated care. In the change of convenient conversation we have worked with the Primary care providers to give us coordinated, integrated, accessible and compressive care with a set of principles know as the Patient centered medical home.
A Patient Centered Medical Home (PCMH) happens when primary care healers keeping that core healing relationship with their patients step up to become specialists in Family and Community Medicine. The move is to the discipline of leading a team that delivers population health management, patent centered prevention, care that is coordination, comprehensive accessible 24/7 and integrated across a deliver system. PCMH happens when the specialists in Family and Community Medicine wake up every morning and ask the question how will my team improve the health of my community today?
All over the world three huge factors are in play that is driving the concept of Patient Centered Medical Home. They are:
1) Cost and demography
2) Information technology and data (information that is actionable will equal a demand for accountability by the payer or buyer of the care)
3) Consumer demand to engage healthcare differently (at least as well as they can their bank- on line) have a question about lab results why not e-mail?
But at its core it is a move toward integration of a healing relationship in primary care and population management all at the point of care with the tools to do just that.
This presentation explains the concept of the patient-centered medical home (PCMH), its function and its intended effects. A brief overview of the history of PCMH is also provided, as well as a discussion of its operational characteristics, its principles and outcomes, and what is expected in the future for the PCMH model.
Partnering with Patients, Families and Communities for Health: A Global Imper...EngagingPatients
Engagement is an essential tool to improving global health. This report introduces a new framework for engagement to help countries assess current programs and think strategically about future engagement opportunities. It spotlights barriers to engagement and offers concrete examples of effective engagement from around the globe.
Patient Centered Medical home talk at WVUPaul Grundy
To employers the cost of healthcare is now a business issue and this talk is about what one large buyer IBM did to drive transformation via broad coalition with other large employers to form the Patient Centered Medical Home movement and the covenant between buyer and provider away from the garbage we now buy episodic uncoordinated disintegrated care. In the change of convenient conversation we have worked with the Primary care providers to give us coordinated, integrated, accessible and compressive care with a set of principles know as the Patient centered medical home.
A Patient Centered Medical Home (PCMH) happens when primary care healers keeping that core healing relationship with their patients step up to become specialists in Family and Community Medicine. The move is to the discipline of leading a team that delivers population health management, patent centered prevention, care that is coordination, comprehensive accessible 24/7 and integrated across a deliver system. PCMH happens when the specialists in Family and Community Medicine wake up every morning and ask the question how will my team improve the health of my community today?
All over the world three huge factors are in play that is driving the concept of Patient Centered Medical Home. They are:
1) Cost and demography
2) Information technology and data (information that is actionable will equal a demand for accountability by the payer or buyer of the care)
3) Consumer demand to engage healthcare differently (at least as well as they can their bank- on line) have a question about lab results why not e-mail?
But at its core it is a move toward integration of a healing relationship in primary care and population management all at the point of care with the tools to do just that.
This presentation explains the concept of the patient-centered medical home (PCMH), its function and its intended effects. A brief overview of the history of PCMH is also provided, as well as a discussion of its operational characteristics, its principles and outcomes, and what is expected in the future for the PCMH model.
Edwina Rogers, executive director of Patient-Centered Primary Care Collaborative, began her presentation by highlighting the movement to advance medical homes.
With the U.S. being the number one in the world for the cost of healthcare and ranked number 37 in the quality category, something needs to change. Rogers discussed the broad stakeholder support and participation for the movement, as well as the incredible volunteer involvement. The four ‘centers’ include: the Center to Promote Public-Payer Implementation, the Center for Multi-Stakeholder Demonstration, the Center for eHealth Information Adoption and Exchange and the Center for Health Benefit Redesign and Implementation. Medical Homes will provide superb access to care, patient engagament in care, clinical information systems, care coordination, team care, patient feedback and publically available information.
Edwards explained that the Obama administration believes the medical homes concept is the best way to approach healthcare reform. The U.S. House of Representatives has showed great support for the movement and is helping develop and allocate funds for a five-year pilot program. She expressed her enthusiasm for the movement and her prediction that the medical home model is certainly the future of health care.
A complete version of Rogers’ presentation on the Patient-Centered Primary Care Collaborative is available online.
The Patient-Centered Medical Home in the Transformation From Healthcare to He...Paul Grundy
Surgeon General of the Navy VADM Matthew L. Nathan, MC USN
Fortunately, we have a way to address this crisis—the
Patient-Centered Medical Home (PCMH) model launched at Naval Hospital Pensacola and Walter Reed National Military Medical Center, Bethesda, Maryland (formerly the National Naval Medical Center) in 2008. It is now being implemented throughout the Military Health System (MHS) and carries great promise. It provides the clinical framework we need to meet our strategic objectives in terms of quality of care, impact on costs, population health, and readiness. One of the most significant benefits of the team-based, collaborative approach is that it allows us to embed within a primary care environment the psychologists, nutritionists, tobacco cessation specialists, mind-body medicine therapists, and health educators our patients need in order to develop and maintain mindful, healthy behaviors—along with the “mental armor,” our active duty military personnel need to increase their operational effectiveness and their resiliency in bouncing back from stressful situations. As we move ahead with this more comprehensive approach to health, we can begin to better address so many of our patients for whom we can find no specific reason for pain and discomfort. The PCMH model also provides a positive impact on our costs. Early data reporting from the PCMH clinics at Bethesda show reduced visits to the emergency room, lowered pharmacy costs, and significant per beneficiary per year savings and improved Healthcare Effectiveness Data and Information Set metrics, access, and patient satisfaction and trust. These positive impacts on the bottom line can be applied directly to improved costs or toward the reallocation of resources from reimbursing those who are sick to the population health-based programs that can make and keep our patients healthy.More significant, however, the PCMH environment allows us to go beyond mere collaboration and to a much more proactive approach to managing our patient populations. It is within the context of the medical home that we can begin to surround our patients with the tools and resources they need to move them from health care to health.
Michigan Hospital Association Governance meetingMary Beth Bolton
Patient centered medical home activities in MI and Nationally and the opportunity to improve quality outcomes by increased access to primary care doctors who outreach members who are missing preventive and chronic care services.
Patient-centered medical homes (PCMHs) are intended to actively provide effective care by physician-led teams, Where patients take a leading role and responsibility. Objective: To determine whether the Walter Reed PCMH has reduced costs while at least maintaining if not improving access to and quality of care, and to determine
whether access, quality, and cost impacts differ by chronic condition status. Design, setting, and patients: This study
conducted a retrospective analysis using a patient-level utilization database to determine the impact of the Walter Reed PCMH on utilization and cost metrics, and a survey of enrollees in the Walter Reed PCMH to address access to care and quality of care. Outcome measures: Inpatient and outpatient utilization, per member per quarter costs, Healthcare Effectiveness Data and Information Set metrics, and composite measures for access, patient satisfaction, provider communication, and customer service are included. Results: Costs were 11% lower for those with chronic conditions compared to 7% lower for those without. Since treating patients with chronic conditions is 4 times more costly than treating patients without such conditions, the vast majority of dollar savings are attributable to chronic care.
The Patient-Centered Medical Home Impact on Cost and Quality: An Annual Revie...CHC Connecticut
Dr. Nwando Olayiwola, Associate Director, Center for Excellence in Primary Care, Assistant Professor, University of California, San Francisco addresses the 2014 Weitzman Symposium on The Patient-Centered Medical Home Impact on Cost and Quality: An Annual Review of Evidence
National Conference on Health and Domestic Violence. Plenary talk Paul Grundy
explaining how the Patient Centered Medical Home (PCMH) platform for healthcare deliver is more likely to support domestic violence prevention and creat a safer environment than the FFS episode of care system we are in now. The medical Home is a home for the data where the all the data goes and is held accountable this idea was first articulated by Dr. Calvin C.J. Sia, a Honolulu-based pediatrician in 1967.
This concept of the medical home was integrated with Ed Wagners Chronic disease Model and Thomas Bodenheimer Kevin Grumbach advanced/proactive primary care at the request of the Patient Centered Primary care Collaborative into a set of principles Know as the Joint principles of the Patient centered medical home.
The patient-centered medical home (PCMH), is a team based health care delivery set of principles led by a physician that provides comprehensive and continuous medical care to patients with the goal of obtaining maximized health outcomes. It is "an approach to providing comprehensive primary care for children, youth and adults" The provision PCMH medical homes allow better access to health care, increase satisfaction with care, and improve health. Joint principles that define a PCMH have been established through the cohesive efforts of the American Academy of Pediatrics (AAP), American Academy of Family Physicians (AAFP), American College of Physicians (ACP), and American Osteopathic Association (AOA).[10] Care coordination is an essential component of the PCMH. Care coordination requires additional resources such as health information technology, and appropriately trained staff to provide coordinated care through team-based models. Additionally, payment models that compensate PCMHs for their effort devoted to care coordination activities and patient-centered care management that fall outside the face-to-face patient encounter may help encourage coordination.
Rob Reid: Redesigning primary care: the Group Health journeyThe King's Fund
Rob Reid, Senior Investigator at Group Health Research Institute, explains the journey taken by Group Health in support of integrated primary care. A case study in how primary care can be delivered effectively and efficiently to a population, Rob laid out the challenges facing general practice in the States, and how Group Health worked to improve the situation for both patients and the workforce.
Dr. Edward Wagner, Director (Emeritus) MacColl Center, Senior Investigator, Group Health Research Institute addresses the 2014 Weitzman Symposium on The Future of Primary Care
Patients and their loved ones often hold critical knowledge that informs diagnosis. This toolkit from the Institute of Medicine offers patients, families and clinicians guidance on how they can collaborate to improve diagnosis.
Edwina Rogers, executive director of Patient-Centered Primary Care Collaborative, began her presentation by highlighting the movement to advance medical homes.
With the U.S. being the number one in the world for the cost of healthcare and ranked number 37 in the quality category, something needs to change. Rogers discussed the broad stakeholder support and participation for the movement, as well as the incredible volunteer involvement. The four ‘centers’ include: the Center to Promote Public-Payer Implementation, the Center for Multi-Stakeholder Demonstration, the Center for eHealth Information Adoption and Exchange and the Center for Health Benefit Redesign and Implementation. Medical Homes will provide superb access to care, patient engagament in care, clinical information systems, care coordination, team care, patient feedback and publically available information.
Edwards explained that the Obama administration believes the medical homes concept is the best way to approach healthcare reform. The U.S. House of Representatives has showed great support for the movement and is helping develop and allocate funds for a five-year pilot program. She expressed her enthusiasm for the movement and her prediction that the medical home model is certainly the future of health care.
A complete version of Rogers’ presentation on the Patient-Centered Primary Care Collaborative is available online.
The Patient-Centered Medical Home in the Transformation From Healthcare to He...Paul Grundy
Surgeon General of the Navy VADM Matthew L. Nathan, MC USN
Fortunately, we have a way to address this crisis—the
Patient-Centered Medical Home (PCMH) model launched at Naval Hospital Pensacola and Walter Reed National Military Medical Center, Bethesda, Maryland (formerly the National Naval Medical Center) in 2008. It is now being implemented throughout the Military Health System (MHS) and carries great promise. It provides the clinical framework we need to meet our strategic objectives in terms of quality of care, impact on costs, population health, and readiness. One of the most significant benefits of the team-based, collaborative approach is that it allows us to embed within a primary care environment the psychologists, nutritionists, tobacco cessation specialists, mind-body medicine therapists, and health educators our patients need in order to develop and maintain mindful, healthy behaviors—along with the “mental armor,” our active duty military personnel need to increase their operational effectiveness and their resiliency in bouncing back from stressful situations. As we move ahead with this more comprehensive approach to health, we can begin to better address so many of our patients for whom we can find no specific reason for pain and discomfort. The PCMH model also provides a positive impact on our costs. Early data reporting from the PCMH clinics at Bethesda show reduced visits to the emergency room, lowered pharmacy costs, and significant per beneficiary per year savings and improved Healthcare Effectiveness Data and Information Set metrics, access, and patient satisfaction and trust. These positive impacts on the bottom line can be applied directly to improved costs or toward the reallocation of resources from reimbursing those who are sick to the population health-based programs that can make and keep our patients healthy.More significant, however, the PCMH environment allows us to go beyond mere collaboration and to a much more proactive approach to managing our patient populations. It is within the context of the medical home that we can begin to surround our patients with the tools and resources they need to move them from health care to health.
Michigan Hospital Association Governance meetingMary Beth Bolton
Patient centered medical home activities in MI and Nationally and the opportunity to improve quality outcomes by increased access to primary care doctors who outreach members who are missing preventive and chronic care services.
Patient-centered medical homes (PCMHs) are intended to actively provide effective care by physician-led teams, Where patients take a leading role and responsibility. Objective: To determine whether the Walter Reed PCMH has reduced costs while at least maintaining if not improving access to and quality of care, and to determine
whether access, quality, and cost impacts differ by chronic condition status. Design, setting, and patients: This study
conducted a retrospective analysis using a patient-level utilization database to determine the impact of the Walter Reed PCMH on utilization and cost metrics, and a survey of enrollees in the Walter Reed PCMH to address access to care and quality of care. Outcome measures: Inpatient and outpatient utilization, per member per quarter costs, Healthcare Effectiveness Data and Information Set metrics, and composite measures for access, patient satisfaction, provider communication, and customer service are included. Results: Costs were 11% lower for those with chronic conditions compared to 7% lower for those without. Since treating patients with chronic conditions is 4 times more costly than treating patients without such conditions, the vast majority of dollar savings are attributable to chronic care.
The Patient-Centered Medical Home Impact on Cost and Quality: An Annual Revie...CHC Connecticut
Dr. Nwando Olayiwola, Associate Director, Center for Excellence in Primary Care, Assistant Professor, University of California, San Francisco addresses the 2014 Weitzman Symposium on The Patient-Centered Medical Home Impact on Cost and Quality: An Annual Review of Evidence
National Conference on Health and Domestic Violence. Plenary talk Paul Grundy
explaining how the Patient Centered Medical Home (PCMH) platform for healthcare deliver is more likely to support domestic violence prevention and creat a safer environment than the FFS episode of care system we are in now. The medical Home is a home for the data where the all the data goes and is held accountable this idea was first articulated by Dr. Calvin C.J. Sia, a Honolulu-based pediatrician in 1967.
This concept of the medical home was integrated with Ed Wagners Chronic disease Model and Thomas Bodenheimer Kevin Grumbach advanced/proactive primary care at the request of the Patient Centered Primary care Collaborative into a set of principles Know as the Joint principles of the Patient centered medical home.
The patient-centered medical home (PCMH), is a team based health care delivery set of principles led by a physician that provides comprehensive and continuous medical care to patients with the goal of obtaining maximized health outcomes. It is "an approach to providing comprehensive primary care for children, youth and adults" The provision PCMH medical homes allow better access to health care, increase satisfaction with care, and improve health. Joint principles that define a PCMH have been established through the cohesive efforts of the American Academy of Pediatrics (AAP), American Academy of Family Physicians (AAFP), American College of Physicians (ACP), and American Osteopathic Association (AOA).[10] Care coordination is an essential component of the PCMH. Care coordination requires additional resources such as health information technology, and appropriately trained staff to provide coordinated care through team-based models. Additionally, payment models that compensate PCMHs for their effort devoted to care coordination activities and patient-centered care management that fall outside the face-to-face patient encounter may help encourage coordination.
Rob Reid: Redesigning primary care: the Group Health journeyThe King's Fund
Rob Reid, Senior Investigator at Group Health Research Institute, explains the journey taken by Group Health in support of integrated primary care. A case study in how primary care can be delivered effectively and efficiently to a population, Rob laid out the challenges facing general practice in the States, and how Group Health worked to improve the situation for both patients and the workforce.
Dr. Edward Wagner, Director (Emeritus) MacColl Center, Senior Investigator, Group Health Research Institute addresses the 2014 Weitzman Symposium on The Future of Primary Care
Patients and their loved ones often hold critical knowledge that informs diagnosis. This toolkit from the Institute of Medicine offers patients, families and clinicians guidance on how they can collaborate to improve diagnosis.
Accountable Care Organizations and Physician Joint Ventures .docxAMMY30
Accountable Care Organizations and Physician Joint Ventures
Jeffrey P. Harrison
Chapter 9
“I will continue with diligence to keep abreast of advances in medicine. I will treat without exception all who seek my ministrations, so long as the treatment of others is not compromised thereby, and I will seek the counsel of particularly skilled physicians where indicated for the benefit of my patient.”
—from The Hippocratic Oath (modern version)
Copyright 2016 Foundation of the American College of Healthcare Executives. Not for sale.
1
Learning Objectives
Demonstrate an understanding of the interparty relationships associated with healthcare joint ventures and accountable care organizations.
Understand some of the dynamics and controversies surrounding the concept of accountable care organizations as an alternative approach to the current marketplace.
Demonstrate a basic understanding of the patient-centered medical home with attention to how it supports network-based delivery systems.
Master the concept of physician–hospital alignment and health system integration including consumer, provider, and regulatory developments.
Assess the emerging role of medical groups and hospital-owned group practices across the continuum of healthcare services.
Copyright 2016 Foundation of the American College of Healthcare Executives. Not for sale.
2
Key Terms and Concepts
Accountable care organization (ACO)
Clinical integration
Equity-based joint venture
Hospitalist model
Integrated physician model
Medical foundation
Patient-centered medical home (PCMH)
Copyright 2016 Foundation of the American College of Healthcare Executives. Not for sale.
3
Introduction
A positive relationship between hospitals and physicians is important to the success of the US healthcare system, because hospitals and physicians can be both collaborators and competitors.
Many hospitals and healthcare systems have moved to various models of physician integration through which hospitals hope to capture market share and physicians seek financial security.
After the Affordable Care Act (ACA) was passed in 2010, physician–hospital alignment became driven by another factor: cost control and quality outcomes in the accountable care era (Reiboldt 2013).
Physicians work in a wide range of settings and serve in leadership positions that have significant responsibility for quality of care.
Copyright 2016 Foundation of the American College of Healthcare Executives. Not for sale.
4
Clinical Integration
What Is It?
Coordination of patient care between hospitals and physicians across the healthcare continuum— e.g., an accountable care organization (ACO).
Provides an opportunity to coordinate services through centralized scheduling, electronic health records, clinical pathways, management of chronic diseases, and innovative quality improvement programs.
Clinical integration is necessary to delivering high-quality, affordable care in the current environment (Jacquin 2014).
Clinical.
This monograph provides an assessment of the current hospital-physician landscape and outlines an innovative vehicle for advancing hospital-physician relationships that has the potential to improve care delivery and coordination, clinical quality, and patient cost. Our findings and recommendations address:• Changes in the market place.• The concept of an integrated medical staff model.• The role of operational clinical integration, enabled by an Electronic Medical• Record, toward creating virtual medical staffs.• Benefits to the hospital, physicians, patients and community.• What boards and senior management can do to move toward the model.
What quality measures does the MCO have in placeSolutionManag.pdfformicreation
What quality measures does the MCO have in place?
Solution
Managed care organizations (MCOs) are responsible for ensuring that persons enrolled in their
plans receive quality health care. In addition, MCOs publicly funded through the Medicare and
Medicaid programs are required by State and Federal governments to meet certain quality
standards.
To fulfill their responsibilities, MCOs need ready access to a comprehensive array of evidence-
based clinical information and other clinical performance measures to enable them to evaluate
their providers\' performance and identify areas where improvement is needed. They also need to
know how their members feel about the care they receive and the way they are treated. Finally,
they need to ensure that both their providers and members are aware of the most recent
preventive care recommendations.
Valid, reliable, and cost-effective measurement tools must be available to make such
determinations, but these tools have not always been available. Furthermore, because the science
of performance measurement is relatively new, additional measures need to be developed and
those that have been developed can be improved. Therefore, to ensure that their enrollees in
MCOs receive high-quality care, MCOs need a reliable source to provide the most current and
scientifically sound tools.
In response to this need, the Agency for Healthcare Research and Quality (AHRQ) has funded
research to compile a database of evidence-based clinical guidelines and to develop clinical
performance measures, member satisfaction surveys, and preventive care recommendations that
can help MCOs meet their responsibilities. Additionally, AHRQ funds research and develops
performance measures and guidelines that MCOs, insurers, providers, and consumers can trust.
This report describes these tools and how they have been used and provides information on
where to learn more about them.
Background
Around one-half of insured Americans are enrolled in some form of managed care. However, as
the number of persons enrolled in MCOs increased in the 1990s, health care purchasers,
policymakers, and other stakeholders became concerned about the potential for health care
quality to diminish. In their view, the policies and practices imposed by MCOs to reduce what
MCOs define as unnecessary care might result in patients not receiving needed care. Therefore,
MCOs faced accreditation systems and other requirements to ensure that patients were receiving
the most appropriate care.
More recently, MCOs have had to address other emerging concerns such as: Rapid introduction
of new technologies, Data showing unexplained variations in the provision of care, Severe cost
pressures.
These factors have provided additional motivation to MCOs to develop systematic ways of
preserving and enhancing health care quality and cost-effectiveness.
Evidence-based practice guidelines and performance measures were developed to help ensure
that patients always receive the most appropri.
Health Care Reform (The Affordable Care Act) .docxisaachwrensch
Health Care Reform (The Affordable Care Act)
“
ANA believes that health care is a basic human right (ANA, 1989, ANA, 1998, ANA 2005). Thus, ANA reaffirms its support for a restructured health care system that assures universal access to a standard package of essential health care services for all citizens and residents.”
“ANA believes that the development and implementation of health policies that reflect the six Institute of Medicine (IOM) aims (Safe/Effective/Patient-centered/Timely/Efficient/Equitable) and are based on outcomes research will ultimately save money.”
“The system must be reshaped and redirected away from the overuse of expensive, technology-driven, acute, hospital-based services in the model we now have, to one in which a balance is struck between high-tech treatment and community-based and preventive services, with emphasis on the latter. The solution is to invert the pyramid and focus more on primary care, thus ultimately requiring less costly secondary and tertiary care.”
Activity:
Please read the attached Health Policy Brief on Basic Health Program and “Nursing’s Role in healthcare reform” from American Nurse Today.
Please go to
www.rnaction.org
, go to the Take Action tab above to access the following information regarding health care reform and the new Affordable Care Act. Scroll down the page to the heading Resources and Supreme Court Challenge to learn more about the health care reform and how it affects you as a nurse and as an individual with a family. Check out all the different information.
HealthCare.gov
Keeping health care reform healthy, patients informed
New Animation Explains Changes Coming for Americans Under Obamacare
(7/13)
Health Care Transformation: The Affordable Care Act and How it Affects Nurses
(3/12)
Health Care Reform Legislation Timeline
ANA Policy and Provisions of Health Reform Law
National Conference of State Legislatures Health Reform Site
Kaiser Family Foundation Health Reform Page
The Supreme Court Decision Matters for Registered Nurses, their Families, and their Patients
ANA Analysis: Supreme Court Arguments on the ACA
ANA to Supreme Court: ‘Individual Mandate’ Needed to Make Health Reform Work
Then proceed to the Kaiser Foundation to watch the following:
http://kff.org
““Health Care Reform Hits Main Street on the Kaiser Foundation website or Youtube. (2010)
“New Animation Explains Changes Coming to Americans under Obamacare” (2013) Youtube or Kaiser Foundation
“
Health insurance Explained: YouToons Have it Covered”
(
2014) Youtube or Kaiser Foundation
If you would like more information regarding the ACA, the Kaiser Foundation is a great source and cover many issues.
http://kff.org
Link:
http://kff.org/health-reform/press-release/new-animation-explains-changes-coming-for-americans-under-obamacar.
Team based care model for better productivityJessica Parker
In an old-fashioned practice model, the physician is solely responsible for most, if not all of the work undertaking of his facility, which also involves charge entry, to medical billing and coding till the time of claims reimbursements.
Heritage Healthcare:-
Legacy healthcare refers to the traditional model of healthcare that has been in vogue for many years. It is characterized by a fee-for-service payment model, where healthcare providers are reimbursed for each service they provide to patients. This model has been a foundation of the US healthcare system for many years, but it has faced increasing criticism for its high costs and inefficiencies. In this essay, we'll explore the history, challenges, and possible solutions to legacy healthcare.
History of Legacy Healthcare
Legacy healthcare emerged in the United States in the early 20th century. At the time, health care was largely provided by individual physicians and hospitals, and patients paid for services out of pocket. However, with the rise of employer-sponsored health insurance during World War II, a new payment model emerged. This model was based on a fee-for-service system, where healthcare providers were reimbursed for each service they provided to patients. The system was designed to encourage healthcare providers to provide more services, with the assumption that more services would lead to better health outcomes.
Over the past few years, the fee-for-service model has become deeply ingrained in the US healthcare system. It has been the foundation of the Medicare and Medicaid programs, which provide healthcare for millions of Americans. However, as the cost of health care continues to rise, the limits of this model are becoming increasingly apparent.
Challenges of Legacy Healthcare
One of the main challenges of legacy healthcare is its high cost. The fee-for-service model incentivizes healthcare providers to provide more services, whether those services are truly needed or not. This has given rise to a phenomenon known as overuse, where patients receive more tests, procedures and treatments than they actually need. This not only increases the cost of health care but can also cause harm to patients. For example, unnecessary tests and procedures can expose patients to radiation and other risks.
Another challenge of legacy healthcare is its fragmentation. The fee-for-service model encourages healthcare providers to work independently of each other, rather than collaborating to provide coordinated care. This can lead to a lack of communication between healthcare providers, resulting in duplication of services and missed opportunities to meet the health needs of patients. Fragmentation also makes it difficult for patients to navigate the health care system, as they may need to see multiple providers for different health problems.
Finally, legacy health care is often criticized for its lack of focus on prevention and population health. The fee-for-service model incentivizes healthcare providers to treat serious illnesses and injuries instead of addressing the underlying causes of poor health. more details
From Patients to ePatients Driving a new paradigm for online clinical collabo...ddbennett
CareTech eHealth Innovation Series
From Patients to ePatients Driving a new paradigm for online clinical collaboration and health management
David Bennett, SVP, Interactive Solutions
StayWell Custom Communications
Anthony Chipelo, Director, Portal Strategies
CareTech Solutions
Robeznieks, A. (2013). What doctor shortage Modern Healthcare, 43.docxSUBHI7
Robeznieks, A. (2013). What doctor shortage? Modern Healthcare, 43(45), 14.
Some experts say changes in delivery will erase need for more physicians
You've heard the grim prognosis many times before. Unless immediate action is taken, the U.S. supply of doctors will be 91,500 short of the number needed by 2020 and 130,600 physicians short by 2025, according to an Association of American Medical Colleges estimate.
Dr. Atul Grover, chief public policy officer at the AAMC, projects that the U.S. needs to train an additional 4,000 doctors a year to avoid a shortage, given the Obamacare insurance expansion, an aging physician workforce, shorter hours worked by younger physicians, and an aging population.
But while some physician and hospital organizations wait for the federal government to pump more money into graduate medical education programs to train additional doctors, other health systems and businesses are using the physician shortage as an opportunity to roll out more cost-effective delivery systems and deploy different types of professionals to provide healthcare.
These innovative organizations are figuring what work needs to be done by a doctor and what work can better be done by different types of providers. They are optimizing the use of different professionals in patient-centered medical homes, accountable care organizations and retail clinics, which may well reduce the number of physicians needed. Some of these changes have been tenaciously opposed by organized medicine, but many physician leaders are embracing the new models.
The physician-shortage crisis is based on assumptions that "could be far from the mark � if the production function for primary care can, indeed, be changed," wrote Dr. Thomas Bodenheimer, adjunct professor at the University of California at San Francisco, and Dr. Mark Smith, president and CEO of the California HealthCare Foundation, in the November issue of Health Affairs, which focused on physician workforce issues. They said the shortage issue could be solved with technology and reallocation of responsibilities.
Dr. Scott Shipman, AAMC director of primary-care affairs, wrote in the same issue of Health Affairs that if physicians reassigned 30 minutes of their daily clerical tasks to a nonphysician in their office and spent that time with one patient, it would generate between 30 million and 40 million more physician visits a year. That's exactly what patient-centered medical-home practices are trying to do.
The new delivery models offer hope in the face of the AAMC's bleak outlook. According to the association, the biggest obstacle to increasing the physician workforce is that Medicare funding of physician training has been essentially frozen since 1997.
While medical and osteopathic school enrollment continues to climb, the number of available residency slots remains stagnant. One result was that 528 graduating medical school seniors did not match with a residency program this year, as many as twice the numb ...
Robeznieks, A. (2013). What doctor shortage Modern Healthcare, 43.docx
Matria Newsletter Spring 2008
1. Also in this Issue
p3 Defining Medical Home Status
Learn about a new set of criteria to recognize physician practices as medical homes.
p4 One Way to Increase DM Participation
Find out how disability integration made a difference in one company’s participation rate.
p5 What differentiates Matria’s
nurseline?
Get the scoop on an exciting new development.
Headlines in
Health & ProductivityThe latest health & productivity news brought to you by Matria SPRING 2008
integrationinformation innovation
Do you have a clear understanding of the
“medical home”?
To make your opinion count, visit
http://tinyurl.com/ysfzpc and fill out the survey!
Want to see survey results from the previous issue?
Visit page 8.
Share and Compare
Hope for U.S.
Healthcare
System
The advanced medical home
model of care could improve the
way primary and principal care
are delivered and financed.
Find out how this model of care works
and how it supports and benefits health
enhancement, in an article by Michael
S. Barr, M.D., M.B.A., FACP, and Jack
Ginsburg, both of the American College of
Physicians. (page 2)
2. Advanced Medical Home
Model of Care Offers Hope for Ailing Healthcare System
By Michael S. Barr, M.D., M.B.A., FACP
and Jack Ginsburg, M.P.E.
T
he U.S. healthcare system is poorly prepared to meet
the current, let alone the future, healthcare needs of
an aging population. Healthcare costs are continuing
to grow faster than the economy, and employers,
government agencies and individuals are straining under
the financial burden.
In this environment, physicians are pressured to see
more patients in less time1
as they are inundated with
administrative paperwork and regulatory requirements. In
addition, they have the added pressure of staying current
with an overload of information in a medical environment
that is increasingly more technical and complicated, and they
struggle to keep their practices afloat in the face of declining
revenues and increasing costs.
Trusting, intimate relationships with patients have suffered
as physicians and patients struggle with the financial and
bureaucratic complexities of public and private insurance
coverage issues, which can cause substantial stress within
patient-physician relationships.2
Physicians also must stay current with ever-expanding
medical knowledge and technology in accord with evolving
medical standards of quality. To make matters worse,
insufficient numbers of young physicians are entering
careers in primary care, and increasing numbers of older
physicians are dissatisfied with their careers and indicate
that they will soon discontinue practice.
In too many instances, unnecessary or inappropriate
healthcare services are provided because there is little
coordination of patient care among providers or across sites
of service.3
As a solution, the American College of Physicians (ACP)
proposed the advanced medical home model which offers
the potential to improve U.S. healthcare by focusing
on strengthening and supporting the patient-physician
relationship. Since the release of the policy paper in January
2006, the ACP, American Academy of Family Physicians,
American Academy of Pediatricians and the American
Osteopathic Association have adopted a set of joint principles
based on each organization’s respective policy.
As a result, the term now used by all of these organizations is
the “Patient-Centered Medical Home” or PCMH. This model
involves a central resource – the PCMH – as the foundation
with a competent team of healthcare providers led by a
personal physician, typically a primary care doctor. The
team would include a physician with training in complex,
chronic care management and coordination, and the team
encourages active involvement by informed patients.
Widespread implementation of this model could result
in positive fundamental changes in the way that primary
care and principal care are delivered and financed. It
recommends:
Provision of enhanced and convenient access to care not•
only through face-to-face visits, but also via telephone,
email, and other modes of communication;
Ongoing, coordinated medical care in partnership with•
patients and their families;
Provision of feedback and guidance on the overall•
performance of physicians and their practices;
Use of evidence-based guidelines and clinical decision•
support tools to guide decision making at the point of
care based on patient-specific factors;
Application of appropriate health information•
technology;
A voluntary recognition process to identify primary care•
and specialty medical practices that provide patient-
centered care based on the principles of the chronic care
model; and
Demonstration of the use of “best practices” to•
consistently and reliably meet the needs of patients
while being accountable for the quality and value of care
provided.
This article is an excerpt from a policy
monograph titled “The Advanced Medical Home:
A Patient-Centered, Physician-Guided Model of
Healthcare” available on the American College of
Physicians Web site at www.acponline.org.
(See “Medical Home” on page 7)
1
Journal of General Internal Medicine, “The Ethical Significance of Time for the Patient-
Physician Relationship”, 2005
2
American College of Physicians, “Medical Professionalism in the Changing Health Care
Environment: Revitalizing Internal Medicine by Focusing on the Patient–Physician
Relationship,” 2005
3
Institute of Medicine, Crossing the Quality Chasm: A New Health System for the 21st
Century, 2001
Michael S. Barr, M.D., M.B.A., FACP
Vice President, Practice Advocacy
and Improvement
Division of Governmental Affairs &
Public Policy
American College of Physicians
Jack Ginsburg, M.P.E.
Director, Health Policy Analysis &
Research
American College of Physicians
2
3. A new set of criteria has been developed to recognize
physician practices as patient-centered medical homes. The
traditional medical home concept is a model of care with
long-term physician-patient relationships at the center of a
coordinated system of care.
The criteria were developed by the National Committee for
Quality Assurance (NCQA) in partnership with the Patient-
Centered Primary Care Collaborative.
Seven principles comprise the characteristics of the medical
home approach:
Personal physician1. – provides first contact and
continuous care.
Physician-directed practice2. – one doctor leads a
team at the practice level.
Whole person orientation3. – physician coordinates
care with other healthcare providers for all stages of life
and levels of illness.
Coordinated care across all the health system4.
– this includes specialist care, subspecialty care,
hospitals, home health agencies, nursing homes, etc.
and is facilitated by technology and health information
exchange. The goal is to have the historical information
necessary to make better health decisions.
Quality and safety5. – healthcare decisions are based
on evidence-based medicine guiding decision-making
and utilization of healthcare technology.
Enhanced access to care6. – this involves new
options for communication between patients, their
personal physicians and practice staff and includes such
measures as open scheduling and expanded hours.
Reformed payment system7. – the payment structure
should be revised to support the cost for meeting the
standards of a medical home practice.
During the summit, NCQA’s Greg Pawlson, M.D., M.P.H.,
executive vice president, described the program as a
“blueprint for the patient-centered medical home” for
physicians to follow.
Pawlson also stressed that
the program would not work
without adequate payment for
physicians to cover the costs
for enhanced access to care
and communication, rewards
for higher value, expanded
administrative, technical
and clinical support, and the
promotion of active patient and
family involvement.
For more information, visit the
PCPCC website at www.pcpcc.net.
Sources: American Medical News, April 9,
2007 and News Now, Nov. 7, 2007
Program Recognizes Medical Home Physician Practices
Industry News
Behind the Medical
Home Concept
In an effort to improve patient-provider relations
and create a more efficient model of healthcare
delivery, several large employers collaborated
with the government to form the Patient-Centered
Primary Care Collaborative (PCPCC). The PCPCC
is a coalition of large national employers, health
benefits companies, trade associations, profession/
affinity groups, academic centers, healthcare quality
improvement associations and the major primary
care physician associations representing 333,000
physicians.
The PCPCC promotes the patient-centered
medical home model of care and provides a forum
for healthcare stakeholders to work together to
improve the healthcare system. It also provides
education to physician practices and Congressional
representatives of the federal and state governments
on the patient-centered medical home model as a
superior form of healthcare delivery.
For more information, visit www.pcpcc.net.
3
4. M
atria Healthcare has been selected to enter into a
strategic relationship with Microsoft Corporation
to support HealthVault, Microsoft’s newly
launched Internet-based health platform.
HealthVault is a consumer-based product that allows
users to search and discover answers to health questions,
confidentially store information regarding their own health
and act on the information to improve their health. Data
gathered by users is secured against theft and loss through
Microsoft’s optimized security platform, and users can
designate accessibility by either a physician, hospital or
other healthcare provider.
HealthVault also allows users to upload health-related data
from numerous biometric digital devices-such as blood
pressure cuffs, heart rate monitors and blood glucose
monitors. Matria’s role in the partnership initially is to
leverage its technological expertise to gather and cleanse
disparate sources of medical data to deliver a clear and
concise personal health record to HealthVault’s users.
Says Microsoft’s Peter Neupert, corporate vice president
for the Health Solutions Group: “Matria Healthcare’s
technology solutions in total population health
enhancement have played a significant role in improving
the health of individuals.”
“When combined with Matria’s proven ability to integrate
and cleanse disparate sources of data from multiple
health information systems and identify care gaps
through products such as our Physician-Patient Care
Alerts,” says Ron Loeppke, M.D., executive vice president
and chief strategic officer for Matria, “we are confident
that HealthVault will provide consumers with the tools
necessary to help manage and improve their health.”
T
o maximize the reach and impact of its existing
health enhancement programs, Matria client
Becton, Dickinson and Company (BD), a worldwide
supplier of medical devices, decided to integrate a new
absence management program with its existing disease
management program.
BD first launched its disease management program with
Matria Healthcare in January 2006 and later formed
a three-way partnership with Unum Corporation – a
disability and absence management provider – in
November of the same year.
The purpose was to identify employees with chronic
conditions earlier, leverage a “teachable moment” to
educate workers about BD’s available health resources and
promote timely outreach to employees, explains Nancy
Lang, vice president of Health Enhancement at Matria
Healthcare.
“BD was interested in Matria’s capacity to receive and
process disability claims via data feeds, use the information
to refer individuals to appropriate programs and then
provide outcomes reporting,” Lang says. “BD believes
employee health is crucial to the company’s success,
and they want to do all they can to increase employee
participation in their programs.”
At the beginning of the program, only 23 percent of
individuals applying for short-term disability reported they
were enrolled in a health enhancement program. Eight
months later, 48 percent self-reported active engagement
in a Matria program.
Other results included improved clinical outcomes across
multiple targeted chronic conditions, reduced emergency
room visits and hospital admissions, and increased
participation among employees with high acuity chronic
medical conditions. One-fifth of all disabled employees
referred for condition management were first identified at
the point of disability filing.
“No competitor has the sophisticated technological
processes that Matria has in place,” Lang says. “Processing
disability claims just gives us one more piece of data
that enhances our ability to identify employees with
chronic conditions and engage their interest in a health
enhancement program.”
BD Increases Participation In
Disease Management Programs
Through Disability Integration
Matria Partners with Microsoft on Web-based Health Tool
Case Study
Industry News
4
5. The only agency that accredits call
centers recently awarded accreditation
to Matria Healthcare Nurse24SM
, the
company’s 24-hour nurse line service.
URAC, a non-profit, independent
accreditation agency, was so impressed
with the nurse line that they offered
three years of accreditation instead of
the usual two.
URAC gave the program a perfect score
and indicated they were impressed
with what they considered to be
excellent case reviews, strong reporting,
knowledgeable and caring nurses and
resourceful physicians. Surveyors were
particularly impressed that Matria will
be consistently auditing and making
continual improvements to its program
as it focuses on continual survey
readiness (CSR).
“We strive to stay accreditation-ready
and have already identified our quality
activities for 2008,” says Tim Burke,
M.S., R.N.C., assistant vice president
of clinical operations for Matria. “We
have always had high standards, and
that starts with having a strong, highly-
experienced and highly-trained staff.
Our accreditation surveyor was really
impressed with our clinicians and
non-clinicians because of their
preparation for this accreditation.
We could not have achieved the
three-year accreditation without
the people doing the job.”
Before the accreditation,
Nurse24 was founded with
telehealth standards developed
and recommended by the American
Association of Ambulatory Care Nurses,
Burke says. This starts with a strong
management structure, 24-hour access
and the monitoring of phone calls, he
adds.
“Accreditation sets us apart from other
organizations, particularly because it
is not required,” says Carol Dall, M.S.,
R.N., director of accreditation and
external audits for Matria. “It shows
that we have gone above and beyond
expectations. The accreditation is a
badge of excellence that assures our
customers and the public that our
program provides the highest standards
of safety, quality and accountability.”
Nurse24 is a telephonic support
program that provides immediate
clinical support for everyday health
issues and questions to the entire
population. The clinical support is
available 24/7 through a toll-free
nurse line service, staffed by highly
trained, registered nurses. It offers a
cost-effective solution for participants
coping with chronic and acute illnesses,
episodic or injury-related events, and
other healthcare issues.
“When someone calls into the nurse
line, they have a problem that needs
to be addressed right away and that
makes them ready to learn,” Dall says.
“Our nurses use national guidelines
of care to help callers and then, if
necessary, refer them to appropriate
Matria programs. The nurse line can
hasten the identification process, which
is an alternative to waiting for claims.”
Matria News
Peer Review Spotlight
Over the past two years,
Matria’s experts have
published more than
70 ground-breaking
and impactful research
studies and articles
in the nation’s most
revered peer-review
medical journals. Our research findings have appeared
in such prestigious publications as the Journal of
Occupational and Environmental Medicine, the
American Heart Journal, and the American Journal of
Obstetrics and Gynecology, among others.
Matria highlighted 39 important articles in a new book
to provide a glance at the industry’s significant findings.
To order your copy of Matria Insights PressBox:
Summaries, Excerpts and Abstracts of Matria Published
Articles on Disease Management, Cost Savings, Health
and Productivity, and Maternity Management, please
email your address to matrianews@matria.com or call
(800) 456-4060.
Participant Engagement
A Priority at Matria
Matria works hard to enroll
as many eligible employees
and health plan members as
we can reach, but sometimes
attracting the interest of
skeptical or hard-to-reach
individuals can be difficult.
That is why we recently
formed a participant
marketing team dedicated
solely to developing targeted messaging and handling
requests for participant communication materials.
From now on, this new team will focus exclusively on the
promotion of all print and electronic communications,
including launch, campaign, enrollment, challenge and
announcement materials for both the standard and
customized packages – all to successfully contact more
individuals and help them understand how our services
can improve their health and quality of life!
24-Hour Nurse Line Earns
URAC Accreditation
5
6. I
n the current healthcare environment,
care is fragmented, patients are
being seen by multiple physicians,
and physicians find it difficult to stay
abreast of ever-expanding evidence-based
knowledge. Avoidable errors and safety
issues are common; health care outcomes
contrast poorly with other industrialized
nations. To make matters worse, the
healthcare system is not adequately
prepared to meet the needs of a rapidly
growing population of elderly individuals
with chronic multiple conditions.
Several new “medical home” proposals
are gaining momentum to deal with these
issues. All endorse the greater role of the primary care physician,
a patient-centered approach handled by a coordinated team of
healthcare providers, emphasis on coordinated care, improvement
in outcomes and better electronic connectivity to support these
efforts.
But the medical home proposals are not without challenges. Only 28
percent of physician practices are currently equipped with electronic
medical records. Many are not capable of receiving and managing
multiple data feeds, nor do they have the staffs to support the team
approach. Other hurdles include the lack of decision support tools
and having to handle multiple payers. Despite these obstacles, the
interest is strong among payers and physicians, and there are likely
to be more evaluations and pilots over the next couple of years by
interested health plans and integrated delivery systems.
Matria has become a well-established leader in bringing patients and
physicians together with impactful, actionable health information
and is well-positioned to support the medical home concept.
Matria’s technology allows us to provide periodic automated reports
and quality care gap alerts to physicians with relevant health
information about their patients gathered from various sources and
stored in our patient electronic records. This information includes
data from medical, pharmacy, and lab claims as well as self-reported
data collected by our clinicians during the delivery of our telephonic
education, compliance monitoring and health coaching services.
Our Care Alerts and individual and population reports inform
physicians when their patients are not meeting nationally
recommended guidelines of care. The system is programmed
with technical algorithms to identify patients with health risks,
patients who have been diagnosed with chronic conditions by
other physicians, or patients with chronic conditions not receiving
national standards of care who are not accessing the system.
Everything we are doing at Matria complements what physicians
want to provide in their practices. A partnership with Matria is an
extension of their practices, allows physicians to meet the standards
of the medical home as well as improve the health and quality of
lives of their patients.
Keeping Participants,
Clients Up-to-Date
Building upon the company’s technological expertise,
Matria is now using Web technology to provide monthly
live interactive educational webinars for clients and
participants in our programs, as well as recorded webcasts
of relevant educational events. Live webinars from client
and participant sessions also are recorded as webcasts to
Matria’s Web site for later viewing.
The first monthly client webinar was held in November
on “Health & Productivity Management: How to Enhance
and Maximize Your Efforts” by Ron Loeppke, M.D.,
executive vice president and chief strategic officer for
Matria, and Thomas Parry, Ph.D., president of the
Integrated Benefits Institute (IBI).
Our second client webinar was hosted live from the Matria
Institute in January featuring Newt Gingrich, founder of
the Center for Health Transformation and former Speaker
of the U.S. House of Representatives. Newt discussed
his vision for the future of the ailing healthcare system,
stressing the important role that technology will play in
bringing the healthcare system into the 21st century.
Matria Insights via the Web also includes exciting
webcasts on the most pressing health and productivity
management issues. Now available on Matria’s Web site
is our first webcast series, “The Bottom Line: Making the
Financial Case for Health Enhancement, Parts I and II,”
in which experts from MGM MIRAGE, IBI and Matria
discuss the financial benefits of investing in health and
productivity.
Matria’s participant webinars so far have featured
discussions by distinguished and highly experienced
specialist physicians on how to reduce the risk for a heart
attack or stroke, depression and pulmonary rehabilitation
for chronic lung disease. Future webinar topics include
bleeding and clotting disorders, managing work and life
disruption and smoking cessation in March.
All Matria Institute sessions are recorded and available as
webcasts following the gathering. To view the webcasts,
visit Matria online (www.matria.com) and click on
Resources, then Matria Insights. A link to the Newt
Gingrich webcast is available from the homepage. You
can’t miss it!
Technology Facilitates
Medical Home Practice
Richard Hodach, M.D.,
Ph.D., MPH
SVP, Chief Medical Officer
Matria Healthcare
Matria News
6
7. As part of the value that Matria brings to its clients,
we participate in industry associations and
conferences. Here’s a glimpse of past and future
activities.
4th Annual Hispanic Health Professional Student
Scholarship Gala Dinner
In November, Matria showed its support for the National
Hispanic Health Foundation by participating as a sponsor
of the gala dinner, held Nov. 29 at the New York Marriott
Marquis Times Square.
IHPM Health Management Conference
March 31 – April 2, 2008
Hyatt Regency Grand Cypress
Orlando, Fla.
http://www.ihpm.org/
Milken Institute Global Conference
April 28-30, 2008
The Beverly Hilton
Beverly Hills, Calif.
http://www.milkeninstitute.org/
V
irtually everyone agrees that the centerpiece of
a successful healthcare ecosystem is the trusted
primary care physician-patient relationship.
Unfortunately, far too many Americans do not have a
long-term primary care relationship. Moreover, for those
that do, certain realities erode the potential power of that
relationship, such as scheduling difficulty, limited visit time
with the physician, lack of data and coordination among
providers, and limited support systems available in the
outpatient setting.
When you contrast inpatient and outpatient settings, certain
powerful differences emerge. And those differences reflect
the reality that America has built the world’s best sickness-
repair ecosystem, but is just beginning to understand the
infrastructure necessary for healthcare.
So, for instance, if a patient were to be admitted to the
hospital with symptoms of a stroke, a multidisciplinary team
working off a single medical record would be mobilized and
coordinated by that primary physician. This team would
likely include laboratory and diagnostic imaging resources,
consultants, nurses, physical therapists, social workers and
others.
Once diagnosed and treated, that patient and physician
would likely meet again in the office, typically with limited
connection to the information and stakeholders so important
to the resolution of the acute illness. To the extent there
would be an ongoing need for multidisciplinary care, with
shared, timely information producing measurably better
care, breakdowns would likely occur.
A positive step toward improved health outcomes and
reduced cost, the medical home concept requires that
primary care physicians drive the long-term coordination of
care across all settings, leveraging all the necessary assets,
including specialists, laboratory, pharmacy, social workers,
health coaches, nutritionists, etc. This is where Matria can
help!
By aligning our nurses, registered dieticians, physicians,
social workers and health coaches around that doctor-patient
relationship, we are able to assist in driving superior care
and outcomes. Our software allows our staff to see errors of
omission and departures from well-recognized standards
of care, such as missed lab tests and non-compliance with
prescribed medication. In the absence of such support, these
errors might otherwise be missed in a world of paper medical
records. There are better days ahead as Matria, patients and
physicians drive the medical home concept to new heights!
Industry Presence A Matria Perspective:
Driving Patients Back
To the Medical Home
Contact Us
If you have questions or ideas for stories in our
upcoming issues, give us a call at (866) 500-4580
or email us at matrianews@matria.com.
The ACP introduced the term “advanced medical home”
to distinguish these practices and called for consideration
and testing of this model of care with four policy positions.
To read the policy, visit www.acponline.org.
The ACP believes that the advanced medical home model
– now referred to as the Patient-Centered Medical Home –
applied in the context of a revised reimbursement system
– could revitalize the patient-physician relationship;
stimulate practice-level innovation; allow practices to invest
in systems-based care and measurement of that care; and
enhance coordination of care across all domains of the
healthcare system.
The concept has garnered significant attention from
consumers, employers, payers, disease management
companies and other stakeholders who are now working
together through the Patient-Centered Primary Care
Collaborative (www.pcpcc.net) to foster the changes
necessary – including legislation, demonstration projects,
and reimbursement reform – to help implement and test the
model.
In addition, the National Committee for Quality Assurance
(NCQA) just released a new version of their Physician
Practice Connections’ recognition program-tailored with
guidance from the ACP, AAFP, AAP and AOA to help identify
practices that deliver care based on the Patient-Centered
Medical Home model.
Medical Home Offers Hope
(continued from page 2)
7
8. Share and Compare
Headlines in
Health & ProductivityThe latest health & productivity news brought to you by Matria SPRING 2008
integrationinformation innovation
In the last issue, we asked you if your organization is actively involved in improving health literacy in
America and, if yes, to indicate types of involvement. One hundred percent of our respondents said yes
to the first question while 80 percent said they invest in health enhancement.
1. My organization is actively involved in health
literacy in America.
2. If yes, that involvement includes the following:
0
10,000
20,000
30,000
40,000
50,000
60,000
70,000
80,000
Cost of Maternity
1 in 3 pregnant
women develop
complications
NICU costs
for preterm &
complications
$80,000
= $6.6 billion
$41,610
$2,830
33%
40%
100%
Healthy
Full-term
Internal programs,
such as Health Enhancement,
wellness and disease
management programs
Partnering with other
organizations in health
literacy improvement efforts
Premature Average
Cost of NICU
Yes
100%
No
0%
0
20
40
60
80
100
33%
40%
100%
Internal programs,
such as Health Enhancement,
wellness and disease
management programs
Partnering with other
organizations in health
literacy improvement efforts
Yes
100%
No
0%