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Paul Grundy, Better Care, Reducing Costs, Improving Service Patient Centered Medical Home
The document outlines the objectives and evidence supporting the Patient-Centered Medical Home (PCMH) model, highlighting its effectiveness in reducing healthcare costs and improving patient care across several states. It details various case studies demonstrating significant reductions in hospitalization and overall healthcare expenditures due to PCMH implementations. Additionally, it emphasizes the importance of care coordination, technology integration, and patient engagement in achieving better health outcomes.
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Paul Grundy, Better Care, Reducing Costs, Improving Service Patient Centered Medical Home
- 1. © 2014 IBMCorporation Smarter Care Cleveland HeartLab Symposium Better Care, Reducing Costs, Improving Service Patient Centered Medical Home Paul Grundy MD, MPH - IBM Director, Healthcare Transformation
- 2. Smarter Care PaulGrundy MD MPH Bio • “Godfather” of the Patient Centered Medical Home • IBM Global Director Healthcare Transformation • President of PCPCC • Member Institute of Medicine • Member Board ACGME • Professor Univ. of Utah Department Family Medicine •Winner NCQA national Quality Award • A Leader of MOH level taskforce primary care transformation 8 nations: USA, Canada, New Zealand, Australia, Holland, Denmark, UK, Belgium, • Univ. of California MD, John Hopkins Trained © 2014 IBM Corporation 2
- 3. Smarter Care Objectives 1) Participant will understand/be able to discuss the important trend of PCMH in health care 2) Participant will understand/be able to explore the rationale and supporting evidence for PCMH 3)Participant will understand/be able comprehend the impact on patients, providers and payers Disclosure – I am a full time Employee of IBM –IBM and other PCPCC executive member companies have supported my talks on PCMH. © 2014 IBM Corporation 3
- 4. Smarter Care Beyond © 2014 IBM Corporation 4
- 5. Away from Episodeof Care to Management of Population Smarter Care Hospital Population Health System Integrator Patient Experience The System Integrator Creates a partnership across the medical neighborhood Drives PCMH primary care redesign Offers a utility for population health © 2014 IBM Corporation 5 and financial management Per Capita Cost Public Health Community Health
- 6. Smarter Care SmarterHealthcare 36.3% Drop in hospital days 32.2% Drop in ER use 12.8% Increase Chronic Medication use -15.6% Total cost 10.5% Drop Inpatient specialty care costs 18.9%Ancillary costs down 15.0%Outpatient specialty down Outcomes of Implementing Patient Centered Medical Home Interventions: A Review of the Evidence from Prospective Evaluation Studies in the US - PCPCC Oct 2012 © 2014 IBM Corporation 6
- 7. Smarter Care MarylandJuly 2014 -- CareFirst saved $267 million with its medical home • 11 percent fewer days in the hospital • 8 percent fewer hospital readmissions. http://www.fiercehealthpayer.com/story/medicaid-can-reap-rewards-medical-homes/2014-07-15 © 2014 IBM Corporation 7
- 8. Smarter Care RuralNew York July 2014 Costs for Medicaid patients dropped from $334 to $266, according to a recent “risk adjusted” analysis. http://poststar.com/news/local/medical-home-program-gains-traction/article_5811380c-2ee9-11e3-8548-001a4bcf887a.html © 2014 IBM Corporation 8
- 9. Smarter Care 24July 2014 Michigan Blues’ patient-centered medical home program shows statewide transformation of care YEAR 6 •9.9 percent lower rate of adult ER visits •27.5 percent lower rate of adult ambulatory care sensitive inpatient stays •11.8 percent lower rate of adult primary care sensitive ER visits •8.7 percent lower rate of adult high-tech radiology usage •14.9 percent lower rate of pediatric ER visits •21.3 percent lower rate of pediatric primary-care sensitive ER visits 4,022 primary care doctors at 1,422 practices around the state in its sixth year of operation. These practices care for more than 1.2 million BCBSM members © 2014 IBM Corporation 9
- 10. Smarter Care ©2014 IBM Corporation 10
- 11. Smarter Care PCMHPennsylvania June, 2014 44% reduction in hospital costs 21% reduction in overall medical costs. 160 PCMH practices Pennsylvania from 2009 to 12 Number of patients with poorly controlled diabetes declined by 45% 44% reduction in hospital costs 21% reduction in overall medical costs. 160 PCMH practices Pennsylvania from 2009 to 12 Number of patients with poorly controlled diabetes declined by 45% Conclusions: PCMH practices had significantly reduced costs and utilization for the highest risk patients, particularly with respect to inpatient care. http://www.ajmc.com/publications/issue/2014/2014-vol20- n3/Medical-Homes-and-Cost-and-Utilization-Among-High- Risk-Patients#sthash.qR8uWb4t.dpuf © 2014 IBM Corporation 11
- 12. Smarter Care OgdenUT , USA 2012 © 2014 IBM Corporation 12
- 13. Smarter Care ©2014 IBM Corporation 13
- 14. Smarter Care MobileFirstPatient Consumer © 2014 IBM Corporation 14
- 15. Smarter Care Today’sCare PCMH Care My patients are those who make appointments to see me My patients are those who make appointments to see me Our patients are the population community Our patients are the population community Care is determined by today’s problem and time available today Care is determined by today’s problem and time available today Care is determined by a proactive plan to meet patient needs with or without visits Care is determined by a proactive plan to meet patient needs with or without visits Care varies by scheduled time and memory or skill of the doctor Care is standardized according to Care varies by scheduled time and memory or skill of the doctor Care is standardized according to evidence-based guidelines evidence-based guidelines I know I deliver high quality care because I’m well trained We measure our quality and make I know I deliver high quality care because I’m well trained Patients are responsible for coordinating their own care Patients are responsible for coordinating their own care We measure our quality and make rapid changes to improve it rapid changes to improve it A prepared team of professionals coordinates all patients’ care A prepared team of professionals coordinates all patients’ care It’s up to the patient to tell us what happened to them It’s up to the patient to tell us what happened to them We track tests & consultations, and follow-up after ED & hospital We track tests & consultations, and follow-up after ED & hospital Clinic operations center on meeting the doctor’s needs Clinic operations center on meeting the doctor’s needs A multidisciplinary team works at the top of our licenses to serve patients A multidisciplinary team works at the top of our licenses to serve patients © 2014 IBM Corporation 15 Slide from Daniel Duffy MD School of Community Medicine Tulsa Oklahoma
- 16. Smarter Care Definingthe Care Centered on Patient Superb Access to Care Patient Engagement in Care Clinical Information Systems, Registry Care Coordination Team Care Communication Patient Feedback Mobile easy to use and Available Information © 2014 IBM Corporation 16
- 17. Smarter Care Trajectoryto Value Based Purchasing: Achieving Real Care Coordination and Outcome Measurement © 2014 IBM Corporation 17 Source: Hudson Valley Initiative
- 18. SPmaarteyr Cmareent reformrequires more than one method, you have dials, adjust them!!! “fee for health” fee for value “fee for outcome” “fee for process” “fee for belonging “fee for service” “fee for satisfaction” © 2014 IBM Corporation 18
- 19. Smarter Care Giveme enough medals and I'll win you any war' Napoleon Bonaparte – not just the $Green$ that brings JOY The Science of Rewards, incentives © 2014 IBM Corporation 19
- 20. Smarter Care BenefitRedesign - Patient Engagement Different Strategies for Different Healthcare Spend Segments % Total Healthcare Spend Those with chronic illness Those with severe, acute illness or injuries % of Members Those who are well or think they are well © 2014 IBM Corporation 20
- 21. Smarter Care Hospitals Specialists PCMH PCMH Public Health Prevention PCMH 2.0 in Action Community Care Team Nurse Coordinator Social Workers Dieticians Community Health Workers Care Coordinators Public Health Prevention HEALTH WELLNESS A Coordinated Health System Health IT Framework Global Information Framework Evaluation Framework Operations © 2014 IBM Corporation 21 35
- 22. Smarter Care Practicetransformation away from episode of care Preventive Medicine Medication Refills Acute Care Nursing Test Results Master Builder DOCTOR © 2014 IBM Corporation 22 Source: Southcentral Foundation, Anchorage AK Behavioral Health Case Manager Medical Assistants Chronic Disease Monitoring
- 23. Smarter Care PCMHParallel Team Flow Design: the glue is real data, not a doctor’s brain Chronic Disease Monitoring Medication Refills Test Results Acute Care Point of Care Testing Preventive Medicine Acute Mental Health Complaint Chronic Disease Compliance Barriers Healthcare Support Team Behavioral Health Medical Assistants Case Manager Provider Source: Southcentral Foundation, Anchorage AK © 2014 IBM Corporation 23
- 24. Smarter Care HealthcareWill Transform Data Driven Every person has a plan Team based Managing a population down to the person . © 2014 IBM Corporation 24
- 25. Smarter Care Thankyou © 2014 IBM Corporation 25
- 26. Smarter Care Acomprehensive approach helps reduce costs while improving care INTERVENTION Identify and influence individuals and populations, and recognize intervention opportunities LEARNING Apply new insights from interactions and outcomes to enable continuous transformation WELLNESS COORDINATION KNOWLEDGE Drive evidence-based and standardized care planning Deliver care and monitor progress across clinical and social requirements COLLABORATION Assess and engage individuals and stakeholders to drive individualized care plans © 2014 IBM Corporation 26 26
- 27. Smarter Care PracticesFeatures -- - Emphasis on care coordination and system navigation, System Integrator, PCMH role for family physician in integrated system - Big push on population health management - Care teams with PCP + a variety of other professions, e.g., nursing, pharmacy, public health and mental health. Technology Use - Better population health data stemming from centralized data based EHR through integrated system. - Adoption of telemedicine, Establish Primary Care Technology Center (PCTC), a research and training entity, to fuel adoption of efficacious technology in practice, patient engagement tools. Modern, flexible, sophisticated system, developed in partnership with technology providers. -Multi-modal communication w/ patients . © 2014 IBM Corporation 27
- 28. Smarter Care Buildinga Workforce -- Training in the use of population health management, data management and public health tools - Dual degrees – MD + MBAs, MPHs - .Add’l training in interprofessional collaboration, EHR data usage, and integrated practice management. Research Focus -- Conclusive evidence about system wide quality improvement and cost savings of robust primary care.- Rise of Continuum-Based Research Networks, applied research efforts to improve clinical pathways. - Research builds case for reductions in Total Cost of Care (at system level), research into technologies most inpactful on Triple Aim. - FM becomes trusted source of best practices to meet Triple Aim, .Focus on issues that relate to patients owning their own health through patient experience and engagement research © 2014 IBM Corporation 28
- 29. Smarter Care Collaboration-- - Family medicine’s partnership with payers and the integrated systems, to exchange ideas about how to best deploy family physicians and represent their colleagues’ interests to these systems - Subspecialists – to ensure great working relationships within systems. - Primary care professionals – to achieve the best possible outcomes in service of Triple Aim. Payers, particularly CMS – to ensure success of alternative payment pilots.- Primary Care Nurse Practitioners (to work together in pursuit of expanded role of Primary Care, Technology manufacturers) to provide advice on how to improve technology in use by FPs, Key Investments -- Curricular overhaul and research effort to prepare residents for work in integrated systems, tools for data being made into actionable information in population management, advance clinical decision support © 2014 IBM Corporation 29
- 30. Smarter Care ©2014 IBM Corporation 30
- 31. Smarter Care ©2014 IBM Corporation 31 31
- 32. Smarter Care 1.Pursue Electronic Patient Management and engagement rather than Electronic Patient Records 2. Bring to bear upon every patient encounter what is known rather than what a particular provider knows. 3. Make it easier to do it right than not to do it at all. 4. Continuous performance improvement. 5. Infuse new knowledge and decision-making tools throughout an organization instantly. © 2014 IBM Corporation 32
- 33. Smarter Care 6.Establish and promote continuity of care with patient education, information and plans of care. 7. Enlist patients as partners and collaborators in their own health improvement. 8. Evaluate the care of patients and populations of patients longitudinally. 9. Audit provider performance based on the Consortium for Physician Performance Improvement Data Sets. 10. Create multiple case-management tools which are integrated in an intuitive and interchangeable fashion giving patients the benefit of expert knowledge about specific conditions while they get the benefit of a global approach to their total health © 2014 IBM Corporation 33
- 34. Smarter Care Trademarksand notes © IBM Corporation 2014 • IBM, the IBM logo, ibm.com, and Cúram are trademarks or registered trademarks of International Business Machines Corporation in the United States, other countries, or both. If these and other IBM trademarked terms are marked on their first occurrence in this information with the appropriate symbol (® or ™), these symbols indicate U.S. registered or common law trademarks owned by IBM at the time this information was published. Such trademarks may also be registered or common law trademarks in other countries. A current list of IBM trademarks is available on the Web at “Copyright and trademark information” at ibm.com/legal/copytrade.shtml. • Other company, product, and service names may be trademarks or service marks of others. • References in this publication to IBM products or services do not imply that IBM intends to make them available in all countries in which IBM operates. © 2014 IBM Corporation 34
Editor's Notes
- #27 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!