The document discusses quality primary care and reducing healthcare costs through the patient centered medical home (PCMH) model. It provides examples of how greater use of technology, care coordination, and evidence-based guidelines in primary care through the PCMH model has led to lower costs through reductions in emergency room visits, hospitalizations, and medical testing in the US and New Zealand. The PCMH model emphasizes proactive, team-based care coordinated around patient needs rather than episodic visits.
Network physicians, hospitals, and other care continuum providers work collaboratively in active clinical process improvement programs across service lines and specialties to define, establish, implement, monitor, evaluate and periodically update the processes of:
- Evidence-based medicine
- Beneficiary engagement
- Care coordination
- Conservation of healthcare resources
- Clinical data reporting
“Documentation not supportive of the RUG-IV classification billed…” is cited as the reason for multiple post-payment medical record review denials. Accurate and concise documentation to support the RUG-IV classification billed is a critical element in gaining accurate reimbursement, and supporting that reimbursement level during a medical review. This presentation covers the technical and clinical requirements for Medicare coverage, and requirements of skilled nursing documentation. The presentation identifies areas of the MDS 3.0 that are vulnerable to error and critical to accurate RUG-IV classification and identify strategies for better supporting these areas in medical record documentation. The correlation between the MDS 3.0 assessment and publicly reported information for the Quality Measures and 5 Star Quality Reporting are discussed.
1. Learn to describe the technical and clinical requirements for Medicare coverage.
2. Understand the goal of supportive skilled nursing documentation.
3. Develop a clear understanding of accurate coding in Section M.
4. Learn to identify sections of the MDS 3.0 assessment that are vulnerable to error and articulate strategies to support these areas in medical record documentation.
5. Learn to identify the correlation between medical record documentation, the MDS 3.0, and publicly reported information for the Quality Measures and 5 Star Quality Rating.
Network physicians, hospitals, and other care continuum providers work collaboratively in active clinical process improvement programs across service lines and specialties to define, establish, implement, monitor, evaluate and periodically update the processes of:
- Evidence-based medicine
- Beneficiary engagement
- Care coordination
- Conservation of healthcare resources
- Clinical data reporting
“Documentation not supportive of the RUG-IV classification billed…” is cited as the reason for multiple post-payment medical record review denials. Accurate and concise documentation to support the RUG-IV classification billed is a critical element in gaining accurate reimbursement, and supporting that reimbursement level during a medical review. This presentation covers the technical and clinical requirements for Medicare coverage, and requirements of skilled nursing documentation. The presentation identifies areas of the MDS 3.0 that are vulnerable to error and critical to accurate RUG-IV classification and identify strategies for better supporting these areas in medical record documentation. The correlation between the MDS 3.0 assessment and publicly reported information for the Quality Measures and 5 Star Quality Reporting are discussed.
1. Learn to describe the technical and clinical requirements for Medicare coverage.
2. Understand the goal of supportive skilled nursing documentation.
3. Develop a clear understanding of accurate coding in Section M.
4. Learn to identify sections of the MDS 3.0 assessment that are vulnerable to error and articulate strategies to support these areas in medical record documentation.
5. Learn to identify the correlation between medical record documentation, the MDS 3.0, and publicly reported information for the Quality Measures and 5 Star Quality Rating.
Presented by Steve Mills, IBM Senior Vice President, Group Executive, Software & Systems Group
Learn more: http://www.ibm.com/software/products/en/category/health-social-programs
Learn more about our simple, smart, fast, and reliable behavioral health solutions. We’ll help you enhance care quality, better coordinate care, streamline workflows, and grow your bottom line.
Developed in conjunction with the Regional Extension Center for Washington DC (eHealthDC). An archived version of the Financing your EHR System Webinar will be available soon for viewing.
How to Build a 5-Star Practice with a Patient-Centered ApproachKareo
Valora Gurganious, MBA, CHBC, Partner, Senior Management Consultant will discuss:
-The importance of an enhanced patient experience and how it affects all aspects of your business such as your collections rate and patient retention
-How adopting technology can help you see more patients daily without the administrative burden
-The areas of your current workflow that can be enhanced to build and maintain positive relationships with your patients
This presentation provides a comprehensive pro-active review of program development for long-term care patients in the SNF. The course outlines suggestions for how rehabilitation team members can strengthen the Medicare Part B programming in the nursing facility. An overview of the Medicare Part B Guidelines, Part B Caps, Functional Limitation G-Codes, and Manual Reviews is also provided. The presentation also discusses Medicare Part B documentation, goal writing and reasons for denied claims.
1. Gain an understanding of Proactive Medicare Part B Program Development and how to strengthen the program components.
2. Gain a better understanding of Medicare Part B documentation components, goal writing and potential risk for receiving denied claims.
3. Gain an understanding of Medicare Part B Guidelines, Medicare Part B Caps, Functional Limitation G-Codes and Medical Reviews.
Getting Paid in 2022: Adapting your Practice to Thrive Within the Healthcare ...Kareo
Kareo and Healthcare Business Consultant, Aimee Heckman, have teamed up to inform you of the latest tools and resources to help get your practice and billers/billing company get ready for any obstacles that may come your way in the new year.
Aimee Heckman will:
-Review the state of the industry in 2021, including surprise billing, data breaches, and penalties.
-Explain the normalization of telehealth and getting paid for telehealth.
-Expand on patient collections and run the business as a business. This includes setting up your practice with a variety of payment options to treat patients more as consumers to improve patient satisfaction.
-Prepare your practice for 2022 with best practices for MIPS, security audits, financial policies, insurance waivers, and patient eligibility
Keep your MDS Coordinators and nursing staff up to speed in understanding the significance of accurate coding in section M and the required corresponding documentation. This presentation enables healthcare providers to provide quality healthcare through an understanding of wound coding in relationship to skin presentation for Section M on the MDS assessment.
1. Gain an understanding of the RAI User’s Manual intent of Section M.
2. Gain an understanding of the documentation required to support Coding in Section M.
3. Develop a clear understanding of accurate coding in Section M.
4. Learn to identify the significance of care planning and utilizing an interdisciplinary approach.
Allina Health used actionable data to identify potential areas of bias, then applied the right interventions to decrease implicit biases. For example, data revealed that the African American populations receiving care at Allina Health were not enrolling in hospice programs when they were eligible because the hospitalists weren’t referring African Americans at the same rate as other populations.
Vivian Anugwom, Health Equity Manager at Allina Health, shares how she led a team to implement new measures, including implicit bias trainings, to help address and overcome these biases to ensure health equity for all.
During this webinar, Vivian will help attendees:
- Understand how Allina Health uses data to identify disparities.
- Define bias and its impact on health disparities.
Patient relationship management on the cloudComidor
Healthcare organizations have realized that having long-term relationships with their customers can help improve their satisfaction and general health. As a result they want to build strong relationships with their patients.The best way to achieve that is the use of Patient Relationship Management (PRM).
Summary -- Patient Centered Medical Home the Necessary Foundation for Accountable Care and Population Management.
In the next 10 years, we will be living in 1) mobile world 2) in the middle of an aging and chronic disease epidemic and 3) data. But , we will also have the ability to analyze data in a cognitive way this will do for doctors’ minds what X-ray and medical imaging have done for their vision. How? By turning data into actionable information. Take, for instance, IBM’s intelligent supercomputer, Watson. Watson can analyze the meaning and con-text of human language and quickly process vast amounts of information. With this in-formation, it can suggest options targeted to a patient’s specific circumstances.
We need the basic foundation to support this transformation a system integrator where data at the level of a patients flows and is held accountable and that model is the Patient Centered Medical Home. (PCMH) starts to happen when clinicians/ healers step up to comprehensive relationship based care empowered by tools to manage the data and communicate effectively. This move to PCMH level care requires 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 and all of that is power by data made into meaningful information.
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.
The Patient-Centered Medical Home (PCMH) lies at the center of the effort to get at population health, integrated and coordinated care. PCMH is where the Primary care healer leads an organization that delivers clinician-led primary care, with comprehensive, accessible, holistic, coordinated, evidence-based coordination and management. In the USA this is now the standard in the US Veterans Administration and the US Military and under the ACA.
Presented by Steve Mills, IBM Senior Vice President, Group Executive, Software & Systems Group
Learn more: http://www.ibm.com/software/products/en/category/health-social-programs
Learn more about our simple, smart, fast, and reliable behavioral health solutions. We’ll help you enhance care quality, better coordinate care, streamline workflows, and grow your bottom line.
Developed in conjunction with the Regional Extension Center for Washington DC (eHealthDC). An archived version of the Financing your EHR System Webinar will be available soon for viewing.
How to Build a 5-Star Practice with a Patient-Centered ApproachKareo
Valora Gurganious, MBA, CHBC, Partner, Senior Management Consultant will discuss:
-The importance of an enhanced patient experience and how it affects all aspects of your business such as your collections rate and patient retention
-How adopting technology can help you see more patients daily without the administrative burden
-The areas of your current workflow that can be enhanced to build and maintain positive relationships with your patients
This presentation provides a comprehensive pro-active review of program development for long-term care patients in the SNF. The course outlines suggestions for how rehabilitation team members can strengthen the Medicare Part B programming in the nursing facility. An overview of the Medicare Part B Guidelines, Part B Caps, Functional Limitation G-Codes, and Manual Reviews is also provided. The presentation also discusses Medicare Part B documentation, goal writing and reasons for denied claims.
1. Gain an understanding of Proactive Medicare Part B Program Development and how to strengthen the program components.
2. Gain a better understanding of Medicare Part B documentation components, goal writing and potential risk for receiving denied claims.
3. Gain an understanding of Medicare Part B Guidelines, Medicare Part B Caps, Functional Limitation G-Codes and Medical Reviews.
Getting Paid in 2022: Adapting your Practice to Thrive Within the Healthcare ...Kareo
Kareo and Healthcare Business Consultant, Aimee Heckman, have teamed up to inform you of the latest tools and resources to help get your practice and billers/billing company get ready for any obstacles that may come your way in the new year.
Aimee Heckman will:
-Review the state of the industry in 2021, including surprise billing, data breaches, and penalties.
-Explain the normalization of telehealth and getting paid for telehealth.
-Expand on patient collections and run the business as a business. This includes setting up your practice with a variety of payment options to treat patients more as consumers to improve patient satisfaction.
-Prepare your practice for 2022 with best practices for MIPS, security audits, financial policies, insurance waivers, and patient eligibility
Keep your MDS Coordinators and nursing staff up to speed in understanding the significance of accurate coding in section M and the required corresponding documentation. This presentation enables healthcare providers to provide quality healthcare through an understanding of wound coding in relationship to skin presentation for Section M on the MDS assessment.
1. Gain an understanding of the RAI User’s Manual intent of Section M.
2. Gain an understanding of the documentation required to support Coding in Section M.
3. Develop a clear understanding of accurate coding in Section M.
4. Learn to identify the significance of care planning and utilizing an interdisciplinary approach.
Allina Health used actionable data to identify potential areas of bias, then applied the right interventions to decrease implicit biases. For example, data revealed that the African American populations receiving care at Allina Health were not enrolling in hospice programs when they were eligible because the hospitalists weren’t referring African Americans at the same rate as other populations.
Vivian Anugwom, Health Equity Manager at Allina Health, shares how she led a team to implement new measures, including implicit bias trainings, to help address and overcome these biases to ensure health equity for all.
During this webinar, Vivian will help attendees:
- Understand how Allina Health uses data to identify disparities.
- Define bias and its impact on health disparities.
Patient relationship management on the cloudComidor
Healthcare organizations have realized that having long-term relationships with their customers can help improve their satisfaction and general health. As a result they want to build strong relationships with their patients.The best way to achieve that is the use of Patient Relationship Management (PRM).
Summary -- Patient Centered Medical Home the Necessary Foundation for Accountable Care and Population Management.
In the next 10 years, we will be living in 1) mobile world 2) in the middle of an aging and chronic disease epidemic and 3) data. But , we will also have the ability to analyze data in a cognitive way this will do for doctors’ minds what X-ray and medical imaging have done for their vision. How? By turning data into actionable information. Take, for instance, IBM’s intelligent supercomputer, Watson. Watson can analyze the meaning and con-text of human language and quickly process vast amounts of information. With this in-formation, it can suggest options targeted to a patient’s specific circumstances.
We need the basic foundation to support this transformation a system integrator where data at the level of a patients flows and is held accountable and that model is the Patient Centered Medical Home. (PCMH) starts to happen when clinicians/ healers step up to comprehensive relationship based care empowered by tools to manage the data and communicate effectively. This move to PCMH level care requires 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 and all of that is power by data made into meaningful information.
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.
The Patient-Centered Medical Home (PCMH) lies at the center of the effort to get at population health, integrated and coordinated care. PCMH is where the Primary care healer leads an organization that delivers clinician-led primary care, with comprehensive, accessible, holistic, coordinated, evidence-based coordination and management. In the USA this is now the standard in the US Veterans Administration and the US Military and under the ACA.
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.
South central foundation Alaska
If you are in a mechanical manufacturing environment then hitting a target is a matter much like the throwing of a rock – figuring out speed trajectory
If you are in a messy, human, complex, adaptive environment it is like throwing a
bird at a target – it is all about the ‘attractor’
Healthcare mostly throws birds at targets and only thinks about the throwing part than wonders why the Human fails to hit the target
Effective integration of specialty practices into medical neighborhoods is likely to require several important environmental precursors. First, a sound infrastructure
design can connect PCMHs to the spectrum of surrounding
specialty practices. An aligned information architecture
will be vital to adequate patient access, care coordination, and communication. Second, a patient centered
neighborhood will rely on an organizational culture that
supports shared learning and transparency of performance and cost data among participating practices. Third, payment incentives will have to be aligned around shared accountability for outcome and cost. Responsibility
for outcomes and total cost of care will have to rest not only with primary care clinicians, but also with specialists who perform(often expensive) procedures and specialty services.The launch of the NCQA’s PCSP recognition program is a sign of a new phase of delivery system reform
New zealand cantabury timmins-ham-sept13Paul Grundy
This is a great example of a community in New Zealand of the interrogation of social services and healthcare. They are changing the demand curve and getting away from “we need more and more resources to see more patients”. The language we use, very deliberately, is “right care, right place, right time”. Once you start getting the whole
system to work as one system, it starts flushing out unnecessary expenditure. So you can do more and/or do it better.’ worth a read.
Better to Best Patient Centered Medical HomePaul Grundy
Better to best -- consensus meeting between large employers, HHS, CMS, DOD OPM, hospitals, Primary care association, AMA, healthcare plans around the elements that add value in the Patient Centered medical home. coordination of care, access to care Health information technology and payment reform.
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.
IBM Smarter care - Impact at Point of CareIBM Government
Health and social care systems are interdependent and each critically affects the other. The ability to transcend these traditional boundaries and work toward the common goal of holistic and individual care is called Smarter Care. For more details click here http://ibm.co/1n3LJio
Partnering for Population Health: Strategies to Promote Collaboration Among t...Conifer Health Solutions
A patient-centered approach to care delivery will bring the best health outcomes for individuals, as well as the community. While it is clear that effective population health management is integral to better health, providers can no longer be the sole proprietors of data and information. Improving a population’s health will depend on strong alliances with community stakeholders that generally have not experienced a strong history of collaboration. In the new healthcare landscape, providers, payers and employers must partner to reduce cost, boost quality and improve the health of their shared populations. These new partnerships may start with a few glitches. However a strategic plan, clear objectives and an engaged, informed patient will smooth the path to improved outcomes.
2016 IBM Interconnect - medical devices transformationElizabeth Koumpan
Emerging technologies such as Internet of Things, 3D Printing are driving the creation of new business models and forcing the Industry for transformation. The product centric model where the Industry main objective was to develop the device, is moving to software and services model, with the focus on Big Data & Analytics, Integration and Cloud.
The maturation of technologies such as social, mobile, analytics, cloud, 3D printing, bio- and nanotechnology are rapidly shifting the competitive landscape. These emerging technologies create an environment that is connected and open, simple and intelligent, fast and scalable. Organizations must embrace disruptive technologies to drive innovation
GeneCIS Communicating the Patient JourneyDMF-Systems
GeneCIS is DMF Systems suite of Clinical Information Systems. GeneCIS communicates the patient journey from the referral right through to discharge. The suite consists of eReferrals, eScheduler, MediViewer, Clinical Summaries and eDischarge.
All of the solutions within the GeneCIS suite can be implemented on a modular basis to ensure you get exactly what you require. Each additional module can be bolted on seamlessly as required. This enables organisations to utilise scarce resources to meet pertinent needs and then grow from there as resources become available.
GeneCIS improves patient outcomes, significantly reduces costs and leads to superior use of scarce hospital resources.
All of the modules can be integrated with the hospital PAS to reduce data entry.
Integration services can also be utilised to revive legacy systems.
Digital technology advancements like Internet of Things (IoT)
* Wearable technologies
* Blockchain
* Robotics
* Big data
*Advanced analytics are changing consumer perceptions
An Overview of Kaiser Permanente - Integration and Information Systems in Hea...Empreender Saúde
Apresentação da Kaiser Permanente para o Brazilian Healthcare Trek: Mission Silicon Valley.
What is Kaiser Permanente?
Kaiser Permanente is committed to helping shape the future of health
care. We are recognized as the largest integrated delivery system in the
U.S. and one of the leading health care providers and not-for-profit
health plans.
Our strategy is to excel in providing high-quality, affordable health care
through our integrated delivery system, our investment in technology,
and our vision of supporting Total Health.
Our Mission and Vision
Mission: to provide high-quality, affordable
health care services and to improve the
health of our members and the communities
we serve.
Vision: To be a leader in Total Health by
making lives better.
7 regions serving 8 states and the District of
Columbia
More than 9.3 million members
More than 17,000 physicians and 174,000
employees (including 48,000 nurses)
38 hospitals (co-located with medical
offices)
608 medical offices and other outpatient
facilities
70 years of providing care (opened in 1945)
Welcome to the Chronic Care Management community. This platform will give you background on payable CCM service codes, identifies eligible practitioners and patients, and details the Medicare PFS billing requirements.
Avident Health created by doctors to allow better teamwork in healthcare and to engage and educate patients. More teamwork leads to value: Better quality at lower cost.
6 reasons fqhcs and chcs benefit from patient referral management softwareGaryRichards30
FQHCs and CHCs provide critical primary care services to tens of millions of people each year in this country. Their role in the front-line of healthcare makes them important entry points for patients entering the broader healthcare system. Let us see how these organizations use patient referral management systems to leverage their role as an important source of patient referrals and improve the care they can provide for their populations.
Direct to Employer - Dealing With Narrow Networks in the 'New Exchange World'McKonly & Asbury, LLP
This webinar was hosted by Tyler Wenger and Suzanne Sentman from McKonly & Asbury with special guest host Ernie Tsoules from Rhoads & Sinon.This presentation addressed the fact that self-insured employers are increasingly seeking to reduce employee health care costs. A new model of achieving this goal is taking hold in the market by employers contracting directly with new types of health care provider networks, commonly referred to as “narrow networks." This session explored the evolution of these new arrangements and its impact on employers, health care providers and employees. The session also addressed the key business and legal issues that are important to consider in developing these new relationships.
Check out our Upcoming Events page for news and updates on our future seminars and webinars at http://www.macpas.com/events/
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.
PCMH implementation, highly associated with important outcomes for both patients and providers. The rate of emergency department visits was significantly
lower in sites with more PCMH effective implementation. Efficient PCMH implementation favorably associated with patient satisfaction, staff burnout, quality of care, and use of health care services.
A systematic review of the challenges to implementation of the patient-centre...Paul Grundy
review the available literature to identify the major challenges and barriers to implementation and adoption of the patient-centred medical home (PCMH) model, topical in current Australian primary care reforms. documents the key challenges and barriers to implementing the PCMH model in United States family practice. It provides valuable
evidence for Australian clinicians, policymakers, and
organisations approaching adoption of PCMH elements
within reform initiatives in Australia.
"'I am proud that MaineCare has been working in partnership with other payers to advance payment reform through greater investment in primary care to both improve outcomes for patients and reduce preventable high cost spending in emergency departments and avoidable inpatient admissions.
– Mary C. Mayhew, Commissioner, Maine Department of Health & Human Services
OVERVIEW -- Care by Design - Putting Care back into healthcare the University of Utah experience in building PCMH level care over the decade of 2001 to . 2011
Care by design magill lloyd successful turnaroundPaul Grundy
The University of Utah purchased a 100-clinician, 9-practice multispecialty primary care network in 1998. The university projected the network to earn a profit the first year of its ownership in a market with growing capitation; however, capitation declined and the network incurred up to a $21 million operating loss per year. This case study describes the financial turnaround of the network.
Care by design 2 bodenheimer teams 2 utah chapterPaul Grundy
Putting Care back into healthcare the University of Utah experience in building PCMH level care. this talks about the team base experice as written up in 2007 by Tom Bodenheimer.
I did a visit to new zealand in 2003 and did a number of talks from 2003 to 2005 on the transformation taking place in new zealand. back in NZ in 2014 so looked at those early slide so impressed with the leadership and the robust primary care
, patients reported higher overall satisfaction at a primary care practice that adopted the patient-centered medical home model along with lean process changes and physician payment reform.
.......................................................................................................
Partial and Incremental PCMH Practice Transformation: Implications for Qualit...Paul Grundy
Experience of BCBS Michigan in Building medical homes
Based on the observed relationships for partial implementation,full implementation of the PCMH model is associated with a 3.5 percent higher quality composite score, a 5.1 percent higher preventive composite score, and $26.37 lower per member per month medical costs for adults. Full PCMH implementation is also associated with a 12.2 percent higher preventive composite score, but no reductions in costs for pediatric populations. Incremental improvements in PCMH model implementation yielded similar positive effects on quality of care for both adult and pediatric populations but were not associated with cost savings for either population.
Conclusions. Estimated effects of the PCMH model on quality and cost of care
appear to improve with the degree of PCMH implementation achieved and with incremental improvements in implementation.
A new 2014 Patient-‐Centered Primary Care Collaborative
analysis found that the patient-‐centered medical home (PCMH) is having a significant impact on reducing costs
of care,unnecessary emergency department (ED) and
hospital visits, as well as increasing the provision of preventive services and improving population health. Among the report’s findings, approximately 60% of the PCMH evaluations reported decreases in cost of care or use of unnecessary/avoidable services, while approximately 30% reported improvements in population health.
Primary Care spend in the State of Rhode island and its impact on overall cost trend a report worth reading for sure
Primary care Spend in RI went up from 47 million in 2008 to 67 million in 2013
BUT !!!
Total Spend went down from 823 Million in 2008 to 661 Million in 2013
Key message:
We are observing leaders across communities of care coming together to support common strategies and activities, focused on improved outcomes. We’re already seeing this happen, centered on a focus on the individual. And a focus on health and wellness -- rather than just acute care, where we know much of the cost is in the system today. Why are leaders / stakeholders coming together? They have common business interests, which can sometimes even result in acquisitions and consolidations.
You can engage with that individual in a number of ways:
Intervention -- where we can identify populations that have common characteristics, where an early intervention can actually improve outcomes, lower costs, prevent larger issues, and minimize future costs.
Knowledge -- where we can do an assessment of what really works best based on evidence and standardized care planning; all of the external information that yields insight to patients/individuals and populations
Collaboration -- where we really want to drive positive health choices, to bring together stakeholders – engaging with the individual, and family members -- to drive and monitor multifaceted care plans. Provide the individual with information and support to make healthy choices; collaborate across care providers and with the individual to ensure individualized care and informed choices.
Coordination – where we are sharing information among and across stakeholders. Coordinating to share knowledge and expertise, sharing a common view of the progress from care plans. Coordinating to adapt or reassess plans and results. (think of meals on wheels, employers sponsored programs, social programs, care providers, home health, etc)
Learning – Really important, because as we learn about how individuals and populations respond, we must continue to evolve. Through constant learning we are analyzing information, interactions, outcomes to guide more informed decisions -- to adapt and evolve best practices. Learning is a result of engaging with multiple individuals in a population and applying the new learning into future interactions and engagements. Ensuring the community of care keeps improving, continually making progress and refining approaches that drive optimal outcomes.
Constant improvement and change, to deliver improved outcomes!