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.
Safety is Personal: Partnering with Patients and Families for the Safest CareEngagingPatients
The work of NPSF"s Lucian Leape Institute's Roundtable on Consumer Engagement, "Safety Is Personal: Partnering with Patients and Families for the Safest Care" is a call to action for health leaders, clinicians, and policy makers to take the necessary steps to ensure patient and family engagement at all levels of health care.The report identifies specific action items for health leaders, clinicians, and policy makers to pursue in making patient and family engagement a core value in the provision of health. care.
Purpose of the Call:
•Provide an overview of the MARQUIS toolkit components, informed by medication reconciliation best practices, designed to help hospitals improve the quality of their medication reconciliation processes
•Preview the preliminary results of the MARQUIS study in order to understand the effects of a mentored quality improvement intervention on medication reconciliation errors
•Discuss lessons learned from study sites that have implemented the MARQUIS program and how they might be applied to Canadian hospitals, including an exploration of barriers to implementation and how to overcome them
•Make the case for provinces, health systems, and hospitals to invest in medication reconciliation quality improvement efforts, and why physicians need to play a major role in these efforts.
Watch the webinar: http://bit.ly/1ji1voq
This infographic speaks to the challenges Emergency Departments face in caring and following up with the growing population of patients they see, and demonstrates how some EDs are seeing measurable improvements in care, patient satisfaction and efficiency.
Safety is Personal: Partnering with Patients and Families for the Safest CareEngagingPatients
The work of NPSF"s Lucian Leape Institute's Roundtable on Consumer Engagement, "Safety Is Personal: Partnering with Patients and Families for the Safest Care" is a call to action for health leaders, clinicians, and policy makers to take the necessary steps to ensure patient and family engagement at all levels of health care.The report identifies specific action items for health leaders, clinicians, and policy makers to pursue in making patient and family engagement a core value in the provision of health. care.
Purpose of the Call:
•Provide an overview of the MARQUIS toolkit components, informed by medication reconciliation best practices, designed to help hospitals improve the quality of their medication reconciliation processes
•Preview the preliminary results of the MARQUIS study in order to understand the effects of a mentored quality improvement intervention on medication reconciliation errors
•Discuss lessons learned from study sites that have implemented the MARQUIS program and how they might be applied to Canadian hospitals, including an exploration of barriers to implementation and how to overcome them
•Make the case for provinces, health systems, and hospitals to invest in medication reconciliation quality improvement efforts, and why physicians need to play a major role in these efforts.
Watch the webinar: http://bit.ly/1ji1voq
This infographic speaks to the challenges Emergency Departments face in caring and following up with the growing population of patients they see, and demonstrates how some EDs are seeing measurable improvements in care, patient satisfaction and efficiency.
In this webinar, you will learn:
How we approach intervention campaigns: a framework
The science of behavior change and how it can be applied to increase the probability of desired outcomes
How Altarum’s ACE Measure can help predict consumer behaviors and design successful intervention campaigns
Speakers:
Ryan Rossier, Medullan
Chris Duke, Altarum
Josh Klapow, ChipRewards
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.
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.
Building Patient-Centeredness in the Real World: The Engaged Patient and the ...EngagingPatients
This paper examines the separate but intertwined ethical, economic and clinical concepts of patientcenteredness and how ACOs provide a structure for turning those concepts into a functioning reality.
Access the webinar here:
http://bit.ly/1eio3ka
Purpose of the Call:
1.Discuss the results of the pan-Canadian survey of existing practices with respect to the use of technology to support Medication Reconciliation (MedRec)
2.Describe the steps and considerations for transitioning to electronic MedRec (eMedRec)
3.Identify factors that support and impede successful migration of paper MedRec to eMedRec.
4.Discuss the lessons learned from research and other organizations.
5.Introduce the toolkit to support healthcare providers in making a safe and effective transition from paper MedRec to eMedRec.
Closing the Loop: Strategies to Extend Care in the EDEngagingPatients
This HIMSS15 presentation discusses the challenges faced in hospital emergency departments and offers insights for implementing a process to follow up with discharged ED patients to enhance outcomes and satisfaction,while optimizing utilization and reducing risk.
Ammonoosuc Community Health Services EMR Medical Record Case StudyGE Healthcare - IT
For Ammonoosuc Community Health Services, an Electronic Medical Record proves essential in delivering award-winning care and achieving Level 3 recognition as a patient-centered medical home
How pharma and healthcare brands can improve their customer experienceJack Morton Worldwide
The SVP and Managing Director of Jack’s Chicago office, Matt Pensinger, presented at Lions Health 2015 with Katie Bang from Eli Lilly and Company about improving the customer experience for patients:
There is growing recognition amongst healthcare brands that understanding the full patient journey is essential for success in today’s healthcare environment. The sheer extent of this both physical and emotional journey, from awareness through to treatment and adherence, opens the patient to many potential experience gaps between their expectations and reality that can lead to frustration, disillusionment and even dropping the prescribed treatment.
So, healthcare companies must understand this journey if they are to improve the customer experience – and offer necessary patient support that extends far beyond a given medication. Being truly effective requires that the entire organisation (from science through to sales) understands the patient journey in order to meet patient needs and effectively engage the many stakeholders that are becoming increasingly important to a therapy’s success.
This is a significant undertaking and healthcare brands and their marketing agencies need to think differently about how they engage with patients and support communications for all the other stakeholders. This talk will examine the experience journey and what it means for the way we market.
Keynote presentation for Mobilizing Computable Biomedical Knowledge Conference 2021. Looking in particular at emerging trends of cognitive assistants, personal health knowledge graphs, and meta descriptions for knowledge resources. Examples taken from RPI-IBM project on Health Empowerment by Analysis, Learning, and Semantics and NIEHS project with RPI-MSSM-Columbia on Human Health Exposure Analysis Repository Data Center.
Purpose of the Call:
Change is challenging and getting staff clinicians and physicians to participate in quality improvement initiatives is often a struggle. Understanding the clinical perspective and developing effective change strategies can help.
By the end of this session participants will:
•understand why it is often difficult to engage with clinicians and physicians
•learn how to assess their change strategies for adoptability
•gain experience with the Highly Adoptable Improvement Model and Toolkit
Watch the webinar http://bit.ly/1A0mxOR
Presentation: The Evolving Patient Journey
Presented by: Meredith Ressi, VP, Multichannel Marketing Solutions, Decision Resources Group
Healthcare communications today require an understanding of the complexity of patient decision making and how patients navigate the health system to get the care they need. What are the emerging trends in patient engagement, and how does channel reliance vary along the treatment continuum?
Engage Front-line Care Team Using Clinical Audit Checklists iCareQuality.us
The culture of patient safety, quality, and transparency is central to improving care delivery at the organization and industry level. Implementing a sustainable frontline solution like quality checklists will require new leadership, innovative thinking, applications of human factor engineering, and patient voices who demand better. We need to reward staff engagement and quality patient safety efforts which can translate into better patient outcomes. CCG, PSO developed a Clinical Audit Checklist program that can support a culture of transparency and accountability, thereby reducing healthcare costs and delivering positive patient outcomes. Together, we can make continuous daily improvement a standard practice at the hospital and system level. Patients are counting on us to make care delivery safer today for a better patient experience tomorrow.
Objectives
1.Understand the importance of measurement in driving improvement
2.Introduce Patient Safety Metrics: a cloud-based tool for data collection and performance monitoring.
3.Demonstrate new auditing tools designed to reduce the burden of measurement
4.Outline the application of Patient Safety Metrics beyond Safer Healthcare Now!
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.
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.
In this webinar, you will learn:
How we approach intervention campaigns: a framework
The science of behavior change and how it can be applied to increase the probability of desired outcomes
How Altarum’s ACE Measure can help predict consumer behaviors and design successful intervention campaigns
Speakers:
Ryan Rossier, Medullan
Chris Duke, Altarum
Josh Klapow, ChipRewards
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.
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.
Building Patient-Centeredness in the Real World: The Engaged Patient and the ...EngagingPatients
This paper examines the separate but intertwined ethical, economic and clinical concepts of patientcenteredness and how ACOs provide a structure for turning those concepts into a functioning reality.
Access the webinar here:
http://bit.ly/1eio3ka
Purpose of the Call:
1.Discuss the results of the pan-Canadian survey of existing practices with respect to the use of technology to support Medication Reconciliation (MedRec)
2.Describe the steps and considerations for transitioning to electronic MedRec (eMedRec)
3.Identify factors that support and impede successful migration of paper MedRec to eMedRec.
4.Discuss the lessons learned from research and other organizations.
5.Introduce the toolkit to support healthcare providers in making a safe and effective transition from paper MedRec to eMedRec.
Closing the Loop: Strategies to Extend Care in the EDEngagingPatients
This HIMSS15 presentation discusses the challenges faced in hospital emergency departments and offers insights for implementing a process to follow up with discharged ED patients to enhance outcomes and satisfaction,while optimizing utilization and reducing risk.
Ammonoosuc Community Health Services EMR Medical Record Case StudyGE Healthcare - IT
For Ammonoosuc Community Health Services, an Electronic Medical Record proves essential in delivering award-winning care and achieving Level 3 recognition as a patient-centered medical home
How pharma and healthcare brands can improve their customer experienceJack Morton Worldwide
The SVP and Managing Director of Jack’s Chicago office, Matt Pensinger, presented at Lions Health 2015 with Katie Bang from Eli Lilly and Company about improving the customer experience for patients:
There is growing recognition amongst healthcare brands that understanding the full patient journey is essential for success in today’s healthcare environment. The sheer extent of this both physical and emotional journey, from awareness through to treatment and adherence, opens the patient to many potential experience gaps between their expectations and reality that can lead to frustration, disillusionment and even dropping the prescribed treatment.
So, healthcare companies must understand this journey if they are to improve the customer experience – and offer necessary patient support that extends far beyond a given medication. Being truly effective requires that the entire organisation (from science through to sales) understands the patient journey in order to meet patient needs and effectively engage the many stakeholders that are becoming increasingly important to a therapy’s success.
This is a significant undertaking and healthcare brands and their marketing agencies need to think differently about how they engage with patients and support communications for all the other stakeholders. This talk will examine the experience journey and what it means for the way we market.
Keynote presentation for Mobilizing Computable Biomedical Knowledge Conference 2021. Looking in particular at emerging trends of cognitive assistants, personal health knowledge graphs, and meta descriptions for knowledge resources. Examples taken from RPI-IBM project on Health Empowerment by Analysis, Learning, and Semantics and NIEHS project with RPI-MSSM-Columbia on Human Health Exposure Analysis Repository Data Center.
Purpose of the Call:
Change is challenging and getting staff clinicians and physicians to participate in quality improvement initiatives is often a struggle. Understanding the clinical perspective and developing effective change strategies can help.
By the end of this session participants will:
•understand why it is often difficult to engage with clinicians and physicians
•learn how to assess their change strategies for adoptability
•gain experience with the Highly Adoptable Improvement Model and Toolkit
Watch the webinar http://bit.ly/1A0mxOR
Presentation: The Evolving Patient Journey
Presented by: Meredith Ressi, VP, Multichannel Marketing Solutions, Decision Resources Group
Healthcare communications today require an understanding of the complexity of patient decision making and how patients navigate the health system to get the care they need. What are the emerging trends in patient engagement, and how does channel reliance vary along the treatment continuum?
Engage Front-line Care Team Using Clinical Audit Checklists iCareQuality.us
The culture of patient safety, quality, and transparency is central to improving care delivery at the organization and industry level. Implementing a sustainable frontline solution like quality checklists will require new leadership, innovative thinking, applications of human factor engineering, and patient voices who demand better. We need to reward staff engagement and quality patient safety efforts which can translate into better patient outcomes. CCG, PSO developed a Clinical Audit Checklist program that can support a culture of transparency and accountability, thereby reducing healthcare costs and delivering positive patient outcomes. Together, we can make continuous daily improvement a standard practice at the hospital and system level. Patients are counting on us to make care delivery safer today for a better patient experience tomorrow.
Objectives
1.Understand the importance of measurement in driving improvement
2.Introduce Patient Safety Metrics: a cloud-based tool for data collection and performance monitoring.
3.Demonstrate new auditing tools designed to reduce the burden of measurement
4.Outline the application of Patient Safety Metrics beyond Safer Healthcare Now!
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.
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.
Background: A unique statewide multipayer initiative in Pennsylvania was undertaken to implement the Patient-Centered Medical Home (PCMH) with diabetes as an initial target disease. it is and one of the largest PCMH multipayer
initiatives.
Results: During the first intervention year (May
2008–May 2009), all practices achieved at least Level 1 National Committee for Quality Assurance (NCQA) Physician
Practice Connections Patient-Centered Medical Home
(PPC-PCMH) recognition. There was significant improvement in the percentage of patients who had evidence-based
complications screening and who were on therapies to reduce morbidity and mortality (statins, angiotensin-converting enzyme inhibitors). In addition, there were small but statistically significant improvements in key clinical parameters for blood pressure and cholesterol levels, with the greatest absolute improvement in the highest-risk patients.
Conclusions: Transforming primary care delivery through
implementation of the PCMH and CCM supported
by multipayer infrastructure
The PCMH is a reality in 16 primary care practices in Colorado that have participated in one of the nation’s first Multi-Payer, Multi-State Patient-Centered Medical Home Pilots, along with stakeholders at both local and national levels. Convened by HealthTeamWorks, the project began in 2008 and runs through 2012.
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
The Multi-StakeholderPatient Centered Medical Home - Movement For Primary Car...Paul Grundy
Paper by Paul Grundy, Senator Kay R. Hagan, AARP President Jennie Chin Hansen and UCSF Dept of Family Med chair Kevin Grumbach on the moment to transform Primary care using the joint principles of the PCMH
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.
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.
Presentation delivered by Steve Neorr, Chief Administrative Officer, Triad HealthCare Network at the marcus evans National Healthcare CXO Summit 2018 in Orlando FL
Key Principles and Approaches to Populaiton Health mManagement - HAS Session 21Health Catalyst
Population Health Management is in its early stages of maturity, suffering from inconsistent definitions and understanding, and is overhyped by vendors and ill-defined by the industry. And yet, many systems are moving forward in innovative pioneering ways to address this growing trend. In this session, you will hear from two very different, successful health systems: a physician-led group and a large integrated delivery system. They will share their best practices, learnings, and different approaches to population health management.
Health Coaching Motivational Interviewing Proficiency Assessmentmkgreco
Overview and validation study of the Health Coaching Performance (HCPA) assessment and reporting tool and system for benchmarking the proficiency of health care professionals in motivational interviewing and evidence-based health coaching.
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
Presentation: Leading the Change In Healthcare Education and Delivery: how to surmount the barriers.
Presented by: Dalal Haldeman, Senior Vice President, Marketing and Communications, John Hopkins Medicine
What does the triple aim really mean and how do we get there? How can strong brands in healthcare influence outcomes, research and patient wellbeing for a healthier future in America and in the world.
Modern Healthcare 2014 Strategic Marketing Conference SlidesModern Healthcare
Thank you for joining us at the inaugural Strategic Marketing Conference, which took place Sept. 23 and 24 in Chicago. We hope you enjoyed the education, engaging in discussions and extending your professional networks.
Click here to view the program guide and agenda from the Strategic Marketing Conference:
http://www.modernhealthcare.com/assets/pdf/CH96416919.PDF
About the Conference:
Modern Healthcare's Strategic Marketing Conference is a two day educational conference that was held September 23 and 24, 2014 at the Hyatt Regency Chicago.
This year’s conference presented thought leaders in healthcare marketing who helped to guide healthcare marketers, focusing on consumer-driven, reform-led and economically necessary challenges. Modern Healthcare's Strategic Marketing Conference is an opportunity for healthcare marketing executives on the provider and supplier side to interact and collaborate on best practices. Throughout two days, the conference provides a unique opportunity for healthcare marketing executives and agencies representing providers, insurers, suppliers and advocacy groups to interact and collaborate on best practices.
Bobby Milstein, PhD, MPH, director of the ReThink Health and visiting scientist at MIT Sloan School of Management, gave the October 9 Grand Rounds on the Future of Public Health at Columbia's Mailman School of Public Health. Dr. Milstein's talk, "Beyond Reform and Rebound: Frontiers for Rethinking and Redirecting Health System Performance," was part of this year's Grand Rounds series focusing on the decline in the health status of the U.S. population compared to peer nations, as well as the opportunities for public health leadership that are needed to close this gap. While at the Mailman School, Dr. Milstein also met with a group of doctoral students and Prof. Ronald Bayer to discuss approaches to effectively improve health systems in the United States.
Visit the events page to find out more, http://www.mailman.columbia.edu/events/grand-rounds.
Presentation given by Eric C. Schneider, MD, Senior Vice President for Policy and Research of The Commonwealth Fund at the University of Michigan Institute for Healthcare Policy and Innovation in Ann Arbor, MI on December 7, 2017.
When appropriately designed, the current shift to value-based reimbursement allows healthcare organizations to compete based on their ability to provide high quality and low-cost care that patients value. To address this challenge many healthcare organizations have successfully developed programs designed to deliver this type of high-value care. These programs typically focus on the needs of a specific segment of a patient population. The most successful programs are artfully crafted to address clinician preferences for providing outstanding care, patient desires for convenience and affordability, and detailed nuances of payment contracts to optimize reimbursement. The complexities of value-based healthcare reimbursement provide tremendous opportunities for organizations that develop thoughtful strategies to provide highly demanded care in a financially sustainable structure. In this workshop, we will interactively review case studies of innovative healthcare programs that have effectively created higher quality care and improved financial outcomes. This discussion will illustrate the concrete steps to develop programs and innovations that will enable your organization to thrive in a value-based environment.
AGENDA
Define value, common reimbursement arrangements and critical reimbursement levers
Discuss the types of risk associated with each reimbursement arrangement
Case studies that examine real-world examples of opportunity, revenue impact, and expense impact
SPEAKERS
Mason Roberts, ASA, MAAA, MBA, Associate Actuary
Stoddard Davenport, Healthcare Management Consultant
Nick Creten, FSA, MAAA, Consulting Actuary
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.
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
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.
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.
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.
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.
.......................................................................................................
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
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.
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
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These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
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Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
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AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
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ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
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New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
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Outcomes pcmh 2014 annual report final
1. The
PatientCentered
Medical
Home’s
Impact on
Cost &
Quality:
An Annual Update
of the Evidence,
2012-2013
January 2014
Authors:
Marci Nielsen, PhD, MPH
J. Nwando Olayiwola, MD, MPH
Paul Grundy, MD, MPH
Kevin Grumbach, MD
Made possible with
support from the
Milbank Memorial Fund
2. ABOUT THE
PATIENT-CENTERED PRIMARY CARE COLLABORATIVE
(PCPCC)
www.pcpcc.org
ABOUT THE
MILBANK MEMORIAL FUND
and The Milbank Quarterly
AUTHORS
Marci Nielsen, PhD, MPH
J. Nwando Olayiwola, MD, MPH
Paul Grundy, MD, MPH
Kevin Grumbach, MD
Contributing Author:
Lisa Dulsky Watkins, MD
PAGE 2
3. ACKNOWLEDGMENTS
Melinda Abrams, MS
The Commonwealth Fund
Asaf Bitton, MD, MPH
Brigham and Women’s Hospital
Harvard Medical School
Mark Gibson
Oregon Health & Science University
Bruce Landon, MD, MBA, MSc
Harvard Medical School
Beth Israel Deaconess Medical Center
Len Nichols, PhD
George Mason University
Kavita Patel, MD
The Brookings Institution
Mary Takach, MPH, RN
National Academy for State Health Policy
Outcomes & Evaluation Stakeholder Center
Amy Gibson, Tara Hacker, Staci GoldbergBelle and Yuki Ueda.
Board of Directors, Executive Membership, and Stakeholder Centers
PAGE 3
4. PCPCC STAFF
Marci Nielsen, PhD, MPH
PCPCC BOARD OF
DIRECTORS
David K. Nace, MD, Chairman
Amy Gibson, RN, MS
Paul Grundy, MD, MPH, President
Michelle Shaljian, MPA
Tara Hacker, MSPH
Douglas Henley, MD, Vice Chairman
Staci GoldbergBelle, MPA
Andrew Webber, Treasurer
Yuki Ueda
Errol Alden, MD
Susan Edgman-Levitan, PA-C
Elizabeth J. Fowler, PhD, JD
Jill Rubin Hummel, JD
Beverley H. Johnson
Hal C. Lawrence III, MD
Harlan Levine, MD
Marci Nielsen, PhD, MPH
Steven E. Weinberger, MD, FACP
Adrienne White-Faines, MPA
Graphic design and layout:
Top Shelf Design, Arlington, VA
PAGE 4
Association
5. TABLE OF CONTENTS
EXECUTIVE SUMMARY.........................................................................6
SECTION ONE
An Overview of the Patient-Centered Medical Home .............................8
........................................................................................................................................... 8
PCMH recognition programs .......................................................................................................... 9
SECTION TWO
Summary of Cost & Quality Results.......................................................10
Methods ........................................................................................................................................... 10
Results ............................................................................................................................................. 10
Table 1. Peer-reviewed reports ...........................................................................................................11
Table 2. Industry-generated reports ..................................................................................................15
Discussion ....................................................................................................................................... 16
Table 3. Number and percent of studies reporting medical home metrics ...........................16
The challenge of studying the PCMH ................................................................................................18
The right metrics.................................................................................................................................18
The right methods...............................................................................................................................18
SECTION THREE
The Future of Primary Care and the PCMH...............................................20
The PCMH’s Role in Delivery System Reform .......................................................................... 20
The foundation of high-performing Accountable Care Organizations ..................................20
A hub for medical neighborhood.........................................................................................................20
The payment reform imperative ..........................................................................................................21
All-payer or multi-payer payment reform ........................................................................................21
Employer and consumer engagement.................................................................................................22
Conclusion....................................................................................................................................... 23
APPENDIX A: PCMH Initiatives and Evidence since 2009 ....................25
APPENDIX B: The Year in Review: Case Study Highlights ....................31
REFERENCES ......................................................................................34
PAGE 5
6. EXECUTIVE SUMMARY
1. PCMH studies continue to demonstrate impressive improvements across a broad
range of categories including: cost, utilization, population health, prevention,
access to care, and patient satisfaction, while a gap still exists in reporting impact
on clinician satisfaction.
Total
Studies
Cost
Reductions
Fewer ED Visits
Fewer Inpatient
Admissions
Fewer
Readmissions
Improvement in
Population Health
Improved
Access
Increase in Preventive
Services
Improvement in
Satisfaction
61%
61%
31%
13%
31%
31%
31%
23%
57%
57%
57%
29%
29%
14%
29%
14%
PEER-REVIEW/ACADEMIA
Reported
outcomes
(n=13)
(n=8)
(n=8)
(n=4)
(n=1)
(n=4)
(n=4)
(n=4)
(n=3)
INDUSTRY REPORTS
Reported
outcomes
(n=7)
(n=4)
(n=4)
(n=4)
(n=2)
(n=2)
• Decreases in the cost of care,
• Reductions in the use of unnecessary or avoidable services,
PAGE 6
(n=1)
(n=2)
(n=1)
7. • Improvements in population health indicators and increase in preventive services, such
• Improvements in access to care,
• Improvements in patient satisfaction
• Future studies should include clinician satisfaction
2. The PCMH continues to play a role in strengthening the larger health care
system, specifically Accountable Care Organizations and the emerging medical
neighborhood model.
As
3. Significant payment reforms are incorporating the PCMH and its key attributes.
strides were
also made this
year in the
private sector,
as commercial
health plans
increasingly
transitioned
their PCMH
pilots into
a standard
business
operation.
PAGE 7
8. SECTION ONE
AN OVERVIEW OF THE PATIENT-CENTERED MEDICAL
HOME
“That high
quality
primary care is
acknowledged
as a key
solution to
the US health
conundrum
makes intuitive
sense. Most
individuals
are closely
connected
to the health
system via their
primary care
practice, and
their primary
care provider
is viewed as
an entryway
to the
complicated
world of health
and health
care.”
20
Person-centered:
PAGE 8
9. • Comprehensive:
• Accessible:
• Coordinated:
• Committed to quality and safety through a systems approach:
PCMH Recognition or Accreditation Programs
philosophy, a subset of
22
“A persistent
challenge
is not only
meeting the
basics of PCMH
recognition,
rather, it is
the capability
of practices
and health
systems to selfsustain their
improvements.”
PAGE 9
10. SECTION TWO
SUMMARY OF COST & QUALITY RESULTS
Methods
(1) peer-reviewed scholarly articles,
(2) “grey literature”
Results
cost &
utilization,
population health & prevention,
access to care,
patient or clinician satisfaction
PAGE 10
11. Table 1. Peer Review-Reported Outcomes 2012-2013, by location and by category
Location/Initiative
Cost & Utilization
Population Health
& Preventive
Services
Access
Patient or Clinician
Satisfaction
Alaska
Alaska Southcentral
Foundation
Nuka System of Care32
•
•
Published:2013
Data Review: 1996-2009
•
visits
•
Colorado
Colorado Multi-Payer
PCMH Pilot 33
Published: Sept. 2012
Data Review: 2009-2012
•
•
•
High patient satisfaction:
•
•
•
•
•
Michigan
BlueCross BlueShield
of Michigan Physician
Group Incentive
Program34
•
•
Published: July 2013
Data Review: 2009-2010
PAGE 11
12. Table 1 continued
Location/Initiative
Cost & Utilization
Population Health
& Preventive
Services
Access
Patient or Clinician
Satisfaction
National
Military Health System
PCMH Initiative 35
For all patients:
•
Published: Feb. 2013
Data Review: 2008-2009
•
•
For all patients:
•
sites
•
•
•
•
•
For those with chronic
conditions:
•
•
•
For those with chronic
conditions:
•
•
•
•
•
National
Veterans Health
Administration Patient
Aligned Care Team
(PACT) 36
•
•
Published: July 2013
Data Review: 2010-2012
•
•
•
•
•
•
New Hampshire
New Hampshire Citizens
Health Initiative 37
•
•
Published: Sept. 2012
Data Review: 2010-2011
PAGE 12
•
13. Table 1 continued
Location/Initiative
Cost & Utilization
Population Health
& Preventive
Services
Access
Patient or Clinician
Satisfaction
New Jersey
Horizon Blue Cross Blue
Shield New Jersey Single
Private Payer Pilot38
•
•
and costs did not
Published: June 2013
Data Review: 2010-2011
•
New York
EmblemHealth High
Value Medical Home
Initiative 39
* randomized trial
Published: June 2013
Data Review: 2008-2010
•
•
•
New York
WellPoint’s Single Health
Plan Model New York
PCMH 40
Published: Sept. 2012
Data Review: 2007-2010
Compared to control
group:
•
•
•
•
Pennsylvania
UPMC Health Plan
Medical Home Pilot 41
•
Published: Nov. 2012
Data Review: 2008-2010
•
•
•
•
Rhode Island
Rhode Island Chronic
Care Sustainability
Initiative 42
•
Published: Nov. 2013
Data Review: 2006 - 2010
•
•
PAGE 13
14. Table 1 continued
Location/Initiative
Cost & Utilization
Population Health
& Preventive
Services
Access
Patient or Clinician
Satisfaction
Utah
University of Utah
Care by Design
Program43
Published: Nov/Dec 2013
Data Review: 2008-2011
For the composite
scores based on team
based care, 2 measures
of productivity and
cost were statistically
Improvement in patient
satisfaction
•
•
•
•
•
•
Improvement in clinician
•
•
Washington
Group Health
Cooperative
PCMH Program 44
* spread of prototype model
to 26 clinics in Washington
and Idaho
•
Published: May/June 2013
Data Review: 2008-2011
PAGE 14
•
15. Table 2. Industry-Reported Outcomes 2012-2013, by location and by category
Initiative
Cost & Utilization
Population Health
& Prevention
Access
Patient and
Clinician
Satisfaction
Alabama
BlueCross BlueShield
Alabama Medical Home
Program 45
•
•
•
Compared to network
avg., PCMHs had:
•
Published: Aug. 2012
Data Review: 2009 - 2011
•
•
•
Connecticut
Connecticut Health
Enhancement Program 46
•
Published: Jan. 2013
Data Review: 2011-2012
•
•
ED visits
•
•
Maryland
CareFirst BlueCross
BlueShield 47
•
Published: June 2013
Data Review: 2010-2012
•
•
savings
incentives achieved
•
incentives
Michigan
Blue Cross Blue Shield
Michigan PCMH
Program48
•
visits
•
Published: July 2013
ED visits
•
sensitive ED visits
•
New Jersey
Horizon BlueCross
BlueShield New Jersey
PCMH Pilot
Monmouth County
Public Employees 49
•
•
Published: Dec. 2013
Data Review: 2012-2013
PAGE 15
16. Table 2 continued
Initiative
Cost & Utilization
Population Health
& Prevention
Access
Patient and
Clinician
Satisfaction
Oregon
Oregon Coordinated
Care Organizations
(CCOs) Oregon Health
Authority 50
Published: Nov. 2013
Data Review: 2012-2013
•
•
visits
•
•
Pennsylvania
Highmark PatientCentered Medical Home
Pilot 51
•
Published: Jan. 2013
Data Review: 2011-2012
•
•
•
diabetics
•
Discussion
Table 3. PCMH Studies from August 2012 to December 2013 that report outcomes (by category and by
frequency)
Total
Studies
Cost
Reductions
Fewer ED Visits
Fewer Inpatient
Admissions
Fewer
Readmissions
Improvement in
Population Health
Improved
Access
Increase in Preventive
Services
Improvement in
Satisfaction
61%
61%
31%
13%
31%
31%
31%
23%
57%
57%
57%
29%
29%
14%
29%
14%
PEER-REVIEW/ACADEMIA
Reported
outcomes
(n=13)
(n=8)
(n=8)
(n=4)
(n=1)
(n=4)
(n=4)
(n=4)
(n=3)
INDUSTRY REPORTS
Reported
outcomes
(n=7)
(n=4)
Decreased Cost and Utilization.
PAGE 16
(n=4)
(n=4)
(n=2)
(n=2)
(n=1)
(n=2)
(n=1)
17. Increased clinical quality and population health.
Improvement in access to care and patient satisfaction.
A gap exists in reporting clinician satisfaction data.
continues
A growing body of evidence points to PCMH success.
In
PAGE 17
18. The Challenge of studying the PCMH
“The question
is not whether
to improve
primary care, and
commensurately
the entire health
system, but how
best to do it.”
The right metrics
60
The right methods
PAGE 18
20. SECTION THREE
THE FUTURE OF PRIMARY CARE AND THE PCMH
The PCMH’s Role in Achieving Delivery System Reform
The foundation of high-performing Accountable Care Organizations
66
and
A hub for the medical neighborhood
PAGE 20
21. The payment reform imperative
All-payer or multi-payer payment reform
PAGE 21
23. MULTI-PAYER INITIATIVES: THE ROLE OF PAYMENT REFORM
VERMONT BLUEPRINT FOR HEALTH
Author: Lisa Dulsky Watkins, MD, Former Associate Director, Vermont Blueprint for Health
The importance of employers and payers investing in the PCMH model is critical because the extent to which
various payers – Medicare, Medicaid, commercial plans, and employers – are aligned around these payment
models is the extent to which true transformation of the US health care system is possible. These “multi-payer”
initiatives convince health care providers that the daunting task of redesigning their clinical practice is worth
the time, effort, and investment because a majority of their payer-mix supports the re-design. 77
The Vermont Blueprint for Health 78 is a striking example of the effectiveness of a successful multi-payer reform
effort. 79 The statewide adoptions of the spectrum of this multifaceted program can be linked to a long-standing
willingness to cultivate collaborative relationships among the various stakeholders. This demonstrable publictheoretical to the implemented.
Over the last decade, Bipartisan support in the public sector had a profound impact on the credibility of Health
Reform. Republican Governor Jim Douglas and an increasingly Democratic State Legislature found common
ground on key aspects of reform, joined by a commitment to grapple with predictions of escalating costs and
increasing morbidity in the aging Vermont population. Initial Blueprint activity was seated at the Vermont
Department of (Public) Health, seen widely as a neutral convener of the disparate groups brought together.
Meaningful engagement of the private sector was essential. From the very beginning, commercial insurers,
to participate in the myriad planning and advisory committees. Attention was paid to the need for national
recognition of practices as PCMHs, the scale of enhanced payments to the practices, the initial development
and payment of the locally based care coordination teams, respect for the internal business processes of the
participating insurers and accountability of the Blueprint to its funders regarding outcomes.
implementation and evaluation strategies to be undertaken. Their commitment to voluntarily support the
Blueprint was evident. There are self-insured employers already participating in the Blueprint despite their
ERISA exemptions, and discussion with others as well as with private payers as the impact on cost and quality
insurers,80 but there remains the impact of the process undertaken in good faith.
making the program “all-payer” through the lens of the practices and payers.
of CMS as a payer was a critical problem in statewide implementation, Vermont leaders were instrumental in
the call for its involvement. The CMS Multi-payer Advanced Primary Care Demonstration, for which Vermont
82
CONCLUSION
PAGE 23
24. Policymakers and advocates
Physicians, clinicians, health professionals, health plans, and academic medicine partners
Patients, families, caregivers
health service researchers, academics, and economists
PAGE 24
25. APPENDIX A: Summary of PCMH evidence by category and
organized by State/Location, with references, 2009-2013
LEGEND
Location Initiative
Blue Cross Blue Shield Alabama Medical Home Program
Medical Home Program Description
Alaska Southcentral Foundation – Noka System of Care
Foundation”
The Annals of Family Medicine
Alaska Native Medical Center
“A new model of health care”
Providence Business News
Orange County, CA Health Care Coverage Initiative (HCCI) – Medical Services Initiative
“Impact of Patient-Centered Medical Home Assignment on Emergency Room Visits Among Uninsured
Patients in a County Health System”
Medical Care Research and Review
CareMore Medical Group, Urban Medical Group, Leon Medical Centers, Redlands Family Practice
“American Medical Home Runs,”
Health Affairs
Blue Cross Blue Shield of California Accountable Care Organization Pilot
Colorado Multi-Payer Patient-Centered Medical Home Pilot
Health Affairs
Reduced Hospital Admissions”
Health Affairs
Colorado Medicaid and State Children’s Health Insurance Program (SCHIP)
Promising Results”
Health Affairs
Health Affairs
PAGE 25
26. APPENDIX A (Cont’d)
Location Initiative
Connecticut
Connecticut Health Enhancement Program
Johns Hopkins University – Guided Care Program (Washington, DC and Baltimore, MD)
American Journal of Managed Care
“Increasing access to health care providers through medical home model may abolish racial disparity in
Journal of the National Medical Association
Capital Health Plan
“Report from Tallahassee Memorial HealthCare on Enhancing Continuity of Care”
Idaho
Blue Cross of Idaho Health Service
State of Illinois Medical Home Pilot
American Journal of Medical Quality,
“Building Community-Based Medical Homes for Children”
CareFirst BlueCross BlueShield
Johns Hopkins University – Guided Care Program (Baltimore, MD and Washington, DC)
American Journal of Managed Care
BlueCross BlueShield of Michigan Physician Group Incentive Program
Health Services Research
HealthPartners
“Patient-Centered Medical Home Cost Reductions Limited to Complex Patients”
American Journal of Managed Care,
The Annals of Family Medicine. 2011.
Costs?
PAGE 26
The Journal of Ambulatory Care Management,
27. APPENDIX A (Cont’d)
Location Initiative
Military Health System Patient-Centered Medical Home Program
Walter Reed National Military Medical Center (Bethesda, MD), Edwards Air Force Base (Lancaster, CA)
Military Medicine
Military Medicine
United States Air Force
Testimony Before the House Appropriations Committee,
Veterans Health Administration Patient Aligned Care Team (PACT) Program
“The Patient-Centered Medical Home in the Veterans Health Administration”
American Journal of Managed Care
Integrated Delivery System”
The Commonwealth Fund
“Medical Homes Require More Than an EMR and Aligned Incentives”
American Journal of Managed Care
PCMH National Demonstration Project – American Academy of Family Physicians
The Annals of Family Medicine
Blue Cross Blue Shield of Nebraska
Lexington Clipper-Herald
New Hampshire Citizens Health Initiative
Health Affairs
Horizon Blue Cross Blue Shield Patient-Centered Medical Home Pilot
New Jersey Family Medicine Research Network
“Principles of the Patient-Centered Medical Home and Preventive Services”
Annals of Family Medicine
Institute for Family Health Patient-Centered Medical Home Program
Centers”
The Annals of Family Medicine,
PAGE 27
28. APPENDIX A (Cont’d)
Location Initiative
WellPoint’s Single Health Plan Model New York Patient Centered Medical Home
Health Affairs
American Journal of Managed Care
EmblemHealth High Value Medical Home Initiative
Trial”
Journal of General Internal Medicine
Community Care of North Carolina (State Medicaid Program)
Conditions”
Health Affairs
Health Affairs,
Annals of Family Medicine
Blue Cross Blue Shield of North Carolina - Blue Quality Physician’s Program
“Blue Cross and Blue Shield Patient-Centered Medical Home Programs Are Improving the Practice and
BlueCross BlueShield of North Dakota MediQHome Quality Program
“Patient-Centered Home Snapshots,”
Fields, et al. Health Affairs
Humana Queen City Physicians
“Senate Panel Looks at Innovative Health Care Strategies,” Kaiser Health News
Oklahoma Medicaid
Promising Results”
Health Affairs
Oregon Coordinated Care Organizations (CCOs) Oregon Health Authority
CareOregon Medicaid and Dual Eligibles
“Bend Memorial Clinic Reduces Hospital Admissions and Emergency Visits”
PAGE 28
29. APPENDIX A (Cont’d)
Location Initiative
UPMC Health Plan Medical Home Pilot
“Results from a patient-centered medical home pilot at UPMC Health Plan hold lessons for broader adoption
of the model”
Health Affairs
Southeast Pennsylvania (SEPA) Multi-Payer Collaborative
“Multipayer patient-centered medical home implementation guided by the chronic care model”
Joint Commission Journal on Quality and Patient Safety
PinnacleHealth
“PinnacleHealth Expands Patient-Centered Medical Home Model,”
Geisinger Health System Proven Health Navigator PCMH Model
American Journal of Managed Care
Health Affairs.
Independence Blue Cross – Pennsylvania Chronic Care Initiative
“Patient-Centered Medical Home Snapshots,”
Highmark Patient-Centered Medical Home Pilot
“Highmark to expand patient-centered medical home efforts to improve care and health outcomes for
members”
Rhode Island Chronic Care Sustainability Initiative
Island Chronic Care Sustainability Initiative Pilot Program”
JAMA Internal Medicine
Blue Cross Blue Shield of Rhode Island
“Patient-Centered Medical Home Snapshots”
Blue Shield Association
Blue Cross Blue Shield of South Carolina, Palmetto Primary Care Physicians
“Patient-Centered Medical Home Snapshots”
BlueCross BlueShield of Tennessee
Patient-Centered Medical Home Snapshots,
BlueCross BlueShield of Texas
WellMed Medical Group
“Case Study of a Primary Care–Based Accountable Care System Approach to Medical Home Transformation”
The Journal of Ambulatory Care Management,
PAGE 29
30. APPENDIX A (Cont’d)
Location Initiative
University of Utah Care by Design (CBD) Program
The Annals of Family Medicine
Intermountain Healthcare Care Management Plus Program
Health Affairs
Vermont Medicaid
Promising Results”
Health Affairs,
Vermont Blueprint for Health
Vermont Blueprint for Health Annual Report
Health Affairs
Health Affairs
Regence Blue Shield Intensive Outpatient Care Program with Boeing
Group Health Cooperative
The Annals of Family Medicine
The Gerontologist
Health Affairs,
The Annals of Family Medicine
Health Affairs
The Commonwealth Fund
American Journal of Managed Care
PAGE 30
31. APPENDIX B. The Year in Review: Case Study Snapshots
Veterans Health Administration Patient Aligned Care Team (PACT)
National Program, 5 million patients
Publication Date: July 2013
RESULTS
BlueCross BlueShield of Michigan Physician Group Incentive Program
Michigan (statewide), 3 million patients
Publication Date: July 2013
RESULTS
•
•
•
•
•
•
PAGE 31
32. UPMC Health Plan
Pennsylvania, 23,390 patients
Publication Date: July 2013
RESULTS
CareFirst Blue Cross Blue Shield
Maryland, 1 million patients
Publication Date: June 2013
RESULTS
PAGE 32
33. Oregon Health Authority Coordinated Care Organizations (CCOs)
Statewide Medicaid Program, 600,000 patients
Publication Date: November 2013
RESULTS
PAGE 33
34. REFERENCES
Health Affairs, 29
2
American Journal of Managed Care,
18
Health Services Research
The Commonwealth Fund
6
Agency for Healthcare Research and Quality
American Journal of Managed Care
The Commonwealth Fund
The Commonwealth Fund
The Commonwealth Fund
The Milbank
Quarterly
Health Affairs, 29
Social Determinants of Health
Patient-Centered Primary Care Collaborative
20
22
PAGE 34
35. REFERENCES CONTINUED
Annals of Family Medicine, 8
Annals of Family Medicine, 11
The Urban Institute
26
The Urban Institute
Annals of Family Medicine, 11
The Urban Institute
PAGE 35
36. REFERENCES CONTINUED
Journal of Ambulatory Care
Management
The Commonwealth Fund
Annals of Family Medicine, 11
Ibid
The Commonwealth Fund
Better Care at Lower Cost:
60
Annals of Family Medicine, 8
JAMA Internal Medicine
PAGE 36
37. REFERENCES CONTINUED
62
JAMA Internal Medicine
American Journal of Managed Care,
18
Health Services Research
66
Kaiser Health News
Ibid
The Commonwealth Fund
Annals of Internal Medicine
Archives of Internal Medicine
American Journal of Managed Care
Agency for Healthcare Research and Quality, Publication
Ibid
NO. 204. AN ACT RELATING TO MANAGED CARE ORGANIZATIONS, THE
BLUEPRINT FOR HEALTH, AND IMMUNIZATIONS OF CHILDREN PRIOR TO ATTENDING SCHOOL AND CHILD CARE
FACILITIES, AND THE IMMUNIZATIONS REGISTRY.
American Journal of Managed Care
PAGE 37
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