The document discusses the patient-centered medical home (PCMH) model, which aims to transform primary care delivery in the US healthcare system. It describes the principles of the PCMH model, including having a personal, long-term relationship with a primary care provider and their care team. The document also notes challenges with the current US system, such as rising costs, lack of care coordination, and physician shortages. It argues that the PCMH model could help address these issues if implemented according to best practices.
Quality and Value-based Healthcare India PresentationJoseph Britto
The document discusses improving healthcare quality and value-based care. It covers elements of quality like safety, effectiveness, efficiency and patient-centeredness. It presents cases showing issues like long wait times and discusses moving from a non-system to a system-based approach. The goal is designing a new healthcare system focused on quality, outcomes and costs through transparency, evidence-based practices, and continuous improvement.
Whsrma 2013 grundy singapore april 2013Paul Grundy
The document discusses the patient centered medical home (PCMH) model which aims to transform healthcare delivery from episodic care to population health management. It provides an overview of the key components of the PCMH model including acting as a system integrator across providers, driving primary care redesign, and offering utilities for population health and financial management. Studies show PCMHs can lead to reductions in hospital and ER use as well as lower overall costs. The PCMH framework focuses on features like patient-centeredness, comprehensive and coordinated care, improved access, and a commitment to quality and safety.
This document discusses the key elements of a successful integrated care program between primary care and psychiatry based on the experiences of Packard Health and Community Support and Treatment Services (CSTS). The three main points are:
1) Many primary care patients have mental health conditions and integrating care can help address these conditions and improve physical health outcomes.
2) Core factors for successful integration include recognizing the need, making a conscious plan, establishing a learning environment, strong leadership, understanding practice capacity, and ensuring appropriate staff roles.
3) Integrated care requires overcoming cultural divides between primary care and psychiatry through education, clear communication of roles, and psychiatrist involvement in areas like consultations, co-visits, and case
This document discusses team-based care in the context of the patient-centered medical home (PCMH) model. It outlines six key qualities of effective team-based care: 1) a physician servant leader, 2) a clear mission and goals, 3) defined roles, 4) strong communication, 5) optimized systems, and 6) enhanced training. The article then provides strategies for implementing team-based care in small practices, noting they have limited resources but are adaptable, and in larger practices with multiple locations. Overall, the document emphasizes that developing the right team is essential before practices can transform to the patient-centered medical home model.
Personalized Health and Care: IT-enabled Personalized HealthcareIBM HealthCare
This document discusses how personalized healthcare (PHC) could help address issues with the science of health promotion and care delivery. PHC aims to use broader patient data and more complete clinical knowledge to promote health, predict/prevent diseases, aid early detection/diagnosis, and manage diseases. However, PHC requires a powerful health information technology environment capable of capturing, storing, analyzing and sharing extensive patient data and clinical knowledge. The current HIT environment is insufficient for PHC and must become more open, robust and able to incorporate continually generated clinical knowledge into decision making.
1. The document discusses organizing healthcare delivery around the goal of improving patient value, defined as health outcomes per dollar spent.
2. It argues that the current healthcare system is not structured or incentivized to achieve this goal, and that fundamental restructuring is needed rather than incremental changes.
3. The strategic agenda outlined involves organizing care into integrated practice units around patient medical conditions, measuring outcomes and costs for every patient, reimbursing through bundled payments for care cycles, and other initiatives to align the healthcare system with the goal of improving patient value.
Quality and Value-based Healthcare India PresentationJoseph Britto
The document discusses improving healthcare quality and value-based care. It covers elements of quality like safety, effectiveness, efficiency and patient-centeredness. It presents cases showing issues like long wait times and discusses moving from a non-system to a system-based approach. The goal is designing a new healthcare system focused on quality, outcomes and costs through transparency, evidence-based practices, and continuous improvement.
Whsrma 2013 grundy singapore april 2013Paul Grundy
The document discusses the patient centered medical home (PCMH) model which aims to transform healthcare delivery from episodic care to population health management. It provides an overview of the key components of the PCMH model including acting as a system integrator across providers, driving primary care redesign, and offering utilities for population health and financial management. Studies show PCMHs can lead to reductions in hospital and ER use as well as lower overall costs. The PCMH framework focuses on features like patient-centeredness, comprehensive and coordinated care, improved access, and a commitment to quality and safety.
This document discusses the key elements of a successful integrated care program between primary care and psychiatry based on the experiences of Packard Health and Community Support and Treatment Services (CSTS). The three main points are:
1) Many primary care patients have mental health conditions and integrating care can help address these conditions and improve physical health outcomes.
2) Core factors for successful integration include recognizing the need, making a conscious plan, establishing a learning environment, strong leadership, understanding practice capacity, and ensuring appropriate staff roles.
3) Integrated care requires overcoming cultural divides between primary care and psychiatry through education, clear communication of roles, and psychiatrist involvement in areas like consultations, co-visits, and case
This document discusses team-based care in the context of the patient-centered medical home (PCMH) model. It outlines six key qualities of effective team-based care: 1) a physician servant leader, 2) a clear mission and goals, 3) defined roles, 4) strong communication, 5) optimized systems, and 6) enhanced training. The article then provides strategies for implementing team-based care in small practices, noting they have limited resources but are adaptable, and in larger practices with multiple locations. Overall, the document emphasizes that developing the right team is essential before practices can transform to the patient-centered medical home model.
Personalized Health and Care: IT-enabled Personalized HealthcareIBM HealthCare
This document discusses how personalized healthcare (PHC) could help address issues with the science of health promotion and care delivery. PHC aims to use broader patient data and more complete clinical knowledge to promote health, predict/prevent diseases, aid early detection/diagnosis, and manage diseases. However, PHC requires a powerful health information technology environment capable of capturing, storing, analyzing and sharing extensive patient data and clinical knowledge. The current HIT environment is insufficient for PHC and must become more open, robust and able to incorporate continually generated clinical knowledge into decision making.
1. The document discusses organizing healthcare delivery around the goal of improving patient value, defined as health outcomes per dollar spent.
2. It argues that the current healthcare system is not structured or incentivized to achieve this goal, and that fundamental restructuring is needed rather than incremental changes.
3. The strategic agenda outlined involves organizing care into integrated practice units around patient medical conditions, measuring outcomes and costs for every patient, reimbursing through bundled payments for care cycles, and other initiatives to align the healthcare system with the goal of improving patient value.
How Does U.S. Health Care Quality Compare Internationally?edocteur
The document compares the quality of health care in the United States to other developed countries. It discusses several key findings:
1) Life expectancy in the US is lower than average among developed countries, though it is above the OECD average at age 65. The US also has higher rates of "amenable mortality" - deaths that could potentially be prevented by health care.
2) Studies of specific health conditions have found mixed results, with the US performing better than peers for some conditions but worse for others. International comparisons of health care quality are limited by differences in data collection across countries.
3) Available evidence suggests opportunities for the US to improve quality in areas like prevention and management of chronic diseases, where access
Patient- and Family Centered Care: "Resident Performance from the Patient's V...hanscomhh5
This document summarizes a presentation about patient and family centered care (PFCC) in graduate medical education. It discusses the history and core values of PFCC, provides examples of how PFCC has been successfully implemented at institutions like the Medical College of Georgia, and shares results from a study that assessed resident performance through patient feedback surveys. The study found patient feedback improved residents' communication, patient care, and systems-based practice skills compared to traditional attending evaluations alone. The presentation concludes PFCC can enhance graduate medical education by providing meaningful feedback to help residents improve.
Krames Patient Education is the only choice for enterprise-wide patient education. In this presentation, practices will learn who Krames Patient Education is and What we can do for you.
We will review Patient-Centered Care and Patient Education; The Case for a Patient Education Investment, The Krames Differencet; Return on Investment; and Krames Solutions.
National Consensus Project Clinical Practice Guidelines Disseminationlsmit132
The document summarizes the 3rd edition of the National Consensus Project for Quality Palliative Care Clinical Practice Guidelines. It was created by a consortium of six palliative care organizations to improve palliative care quality in the US. The guidelines provide recommendations for interdisciplinary palliative care delivery across various clinical domains and settings. The 3rd edition features expanded recommendations regarding palliative care delivery requirements and quality standards based on recent healthcare reforms and evidence.
The document discusses effective adherence to medical treatment regimens. It notes that non-adherence is a complex problem with many interrelated behavioral and psychological causes. It proposes that a comprehensive behavioral program using a customizable software platform can help address non-adherence by providing personalized support that targets the cognitive, emotional, behavioral, and environmental factors influencing each individual patient.
This document discusses the growing recognition of integrating patients and families into healthcare planning and delivery through a model of patient- and family-centered care. It provides examples from individual hospitals and healthcare systems that are partnering with patients at all levels from direct care to policy-making and education. The key aspects of patient- and family-centered care involve dignity and respect, information sharing, participation in decision-making, and collaboration between patients, families and healthcare providers.
Steve Shortell: Integrated care: Policy and evidenceNuffield Trust
This document discusses integrated care and provides evidence in support of more integrated models of care delivery. It makes three key points:
1) Current healthcare systems often fail to provide integrated care for patients with chronic conditions who require care from both primary physicians and hospitals. Effective coordination of this care can result in better outcomes and lower costs.
2) Integrated delivery systems (IDS) that provide coordinated, team-based care show promise in improving quality of care and health outcomes, especially for patients with chronic conditions. The Veterans Health Administration and Kaiser Permanente are cited as examples of high performing IDS models.
3) Evidence suggests that use of elements of the Chronic Care Model, such as patient registries, self
The document discusses several key points about palliative care:
1) Palliative care aims to relieve suffering and improve quality of life for patients with advanced illnesses alongside medical treatment.
2) Two studies found that early palliative care led to improved quality of life and mood, less aggressive end-of-life care, and longer survival times for cancer patients.
3) A study of Medicaid patients found that palliative care consultations reduced hospital costs without reducing quality of care.
Ader et al (2015) The Medical Home and Integrated Behavioral Health Advancing...Ben Miller
This document discusses recommendations for advancing the integration of behavioral health and primary care. It recommends:
1. Building demonstration projects to test integrated care approaches and evaluate them using standardized measures.
2. Developing training programs for integrated care teams, which typically include the patient, primary care provider, behavioral health specialist, and care manager.
3. Implementing population-based strategies to improve behavioral health and strengthen relationships between practices and community resources.
Michael heffer interprofessional collaborationLornestar
This document discusses interprofessional collaboration (IPC) and provides examples from St. Joseph's Health Centre of how IPC has been implemented. Some key points:
1) IPC involves intentional learning with, from, and about other professions to improve individual and team capacity and patient outcomes.
2) Government support through initiatives like funding academic health science centres has helped establish IPC. Hospitals also need senior leadership buy-in and dedicated roles to promote IPC.
3) St. Joseph's has implemented structures like an interprofessional advisory committee and point of care teams to facilitate IPC. Change leaders and competency frameworks also support its adoption.
4) Evaluating initiatives like St. Joseph
This document provides an overview and introduction to palliative care. It discusses that palliative care focuses on relieving pain, symptoms and stress of serious illness to improve quality of life. Palliative care is delivered by an interdisciplinary team and can be provided at any stage of a serious illness alongside curative treatments. The document summarizes research finding that palliative care can reduce costs by lowering hospitalizations and emergency visits while improving quality outcomes like symptoms and satisfaction. It also outlines strategies some health payers and organizations are taking to integrate palliative care, like targeting high-risk patients, dedicating case management resources and reimbursing providers.
This document discusses integrated primary care models for delivering behavioral health services. It reviews literature showing that treating behavioral health disorders can reduce overall healthcare costs. While most people receive mental health care from primary care physicians, integrated models aim to better coordinate behavioral health specialists with primary care teams. The document explores a variety of integrated models and the roles of behavioral health consultants in providing brief, targeted interventions to support primary care providers in treating behavioral health issues.
An Interprofessional Approach to Substance Abuse in Primary CareASAMPUBS
An integrated model of treatment improves care by recognizing that patients need clear and consistent care from their primary care provider “in a way that thoroughly considers biological, social, behavioral, and psychological components of their presenting complaint” by integrating psychological, addiction, and other treatments into a cohesive whole.
This document discusses collaborative practice in healthcare. It defines collaborative practice as developing effective working relationships between practitioners, patients, and communities to improve health outcomes. The benefits of collaborative practice include better patient care and health outcomes, increased job satisfaction and productivity, and a more sustainable and cost-effective healthcare system. Studies show collaborative practices between physicians and other healthcare providers can decrease hospitalizations, lower health metrics like blood pressure, and improve patient symptoms. The document outlines steps to implement collaborative practice through clarifying roles, improving communication, and assessing practices using tools like the Queen's University Collaborative Practice Assessment Tool. It stresses the importance of clear roles and accountability to reduce liability risks.
Design Research and Healthcare Reform - Mayo Clinic ProceedingsChristine Chastain
This document describes research conducted in Austin, Minnesota to understand community health needs and inform the design of a new healthcare delivery system using a patient-centered approach. Mixed qualitative and quantitative methods were used, including surveys of 487 community members. The research found significant disparities between English and Spanish-speaking residents in areas like income, education, employment, health insurance coverage, and access to care. These disparities represent barriers to achieving the goals of improved health outcomes and lower costs. The researchers conclude that effective healthcare system design should focus on creating health rather than just healthcare, and should be informed by deep understanding of community needs and context gained through design research methods.
Dr. Edward Wagner, Director (Emeritus) MacColl Center, Senior Investigator, Group Health Research Institute addresses the 2014 Weitzman Symposium on The Future of Primary Care
This document summarizes the final report from the Forum on Teamworking in Primary Healthcare. The forum was convened by several national healthcare organizations to examine teamworking in primary care. The report found evidence that effective teamwork occurs when roles are clearly defined and rewarding, communication is good, and there are shared goals. It identified barriers like competing demands, status differences, and lack of resources. The report provides recommendations to improve teamworking at both the organizational and team member levels. It also highlights several examples of successful teamworking initiatives in UK primary care settings.
Kingley Health has developed an integrated healthcare model to more effectively treat chronic lifestyle diseases like obesity. It reorganizes traditional components like primary physicians and specialists under Wellness Advisors to provide coordinated care. This improves clinical outcomes and compliance rates compared to the fragmented status quo. Kingley Health also aims to enhance the customer experience through shorter wait times and a supportive environment. Financially, its model generates more revenue per visit than typical practices by billing each service separately while presenting an integrated experience to patients. The document outlines how Kingley Health addresses limitations of the current U.S. healthcare system in managing chronic conditions.
The document discusses the future of nursing and healthcare. It outlines challenges facing the US healthcare system including rising costs and access issues. It also discusses challenges and opportunities for nursing including an aging population, need for higher levels of education, and calls to expand nursing's leadership role. The IOM report on nursing recommends increasing the proportion of nurses with bachelor's degrees and doubling the number with doctorates by 2020 to help transform the healthcare system and improve outcomes.
The document discusses key questions around the healthcare business model in the 21st century UK. It questions who the customers are for social enterprises and what constitutes an effective healthcare business model. It explores issues like personalization of care, fully engaging patients, and the challenge of relating needs to markets within a shared risk framework. The central problem addressed is how to develop sustainable business and service models that work with customers to meet their needs through innovative and authentic approaches.
The document provides an overview of the NCQA PCMH 2011 standards and guidelines, outlining the six standards, key elements and factors, requirements around must pass elements and meaningful use, and the process for practices to complete a self-assessment and apply for recognition. It also discusses the benefits of achieving PCMH recognition and the multiple efforts supporting primary care practices through the transformation process.
How Does U.S. Health Care Quality Compare Internationally?edocteur
The document compares the quality of health care in the United States to other developed countries. It discusses several key findings:
1) Life expectancy in the US is lower than average among developed countries, though it is above the OECD average at age 65. The US also has higher rates of "amenable mortality" - deaths that could potentially be prevented by health care.
2) Studies of specific health conditions have found mixed results, with the US performing better than peers for some conditions but worse for others. International comparisons of health care quality are limited by differences in data collection across countries.
3) Available evidence suggests opportunities for the US to improve quality in areas like prevention and management of chronic diseases, where access
Patient- and Family Centered Care: "Resident Performance from the Patient's V...hanscomhh5
This document summarizes a presentation about patient and family centered care (PFCC) in graduate medical education. It discusses the history and core values of PFCC, provides examples of how PFCC has been successfully implemented at institutions like the Medical College of Georgia, and shares results from a study that assessed resident performance through patient feedback surveys. The study found patient feedback improved residents' communication, patient care, and systems-based practice skills compared to traditional attending evaluations alone. The presentation concludes PFCC can enhance graduate medical education by providing meaningful feedback to help residents improve.
Krames Patient Education is the only choice for enterprise-wide patient education. In this presentation, practices will learn who Krames Patient Education is and What we can do for you.
We will review Patient-Centered Care and Patient Education; The Case for a Patient Education Investment, The Krames Differencet; Return on Investment; and Krames Solutions.
National Consensus Project Clinical Practice Guidelines Disseminationlsmit132
The document summarizes the 3rd edition of the National Consensus Project for Quality Palliative Care Clinical Practice Guidelines. It was created by a consortium of six palliative care organizations to improve palliative care quality in the US. The guidelines provide recommendations for interdisciplinary palliative care delivery across various clinical domains and settings. The 3rd edition features expanded recommendations regarding palliative care delivery requirements and quality standards based on recent healthcare reforms and evidence.
The document discusses effective adherence to medical treatment regimens. It notes that non-adherence is a complex problem with many interrelated behavioral and psychological causes. It proposes that a comprehensive behavioral program using a customizable software platform can help address non-adherence by providing personalized support that targets the cognitive, emotional, behavioral, and environmental factors influencing each individual patient.
This document discusses the growing recognition of integrating patients and families into healthcare planning and delivery through a model of patient- and family-centered care. It provides examples from individual hospitals and healthcare systems that are partnering with patients at all levels from direct care to policy-making and education. The key aspects of patient- and family-centered care involve dignity and respect, information sharing, participation in decision-making, and collaboration between patients, families and healthcare providers.
Steve Shortell: Integrated care: Policy and evidenceNuffield Trust
This document discusses integrated care and provides evidence in support of more integrated models of care delivery. It makes three key points:
1) Current healthcare systems often fail to provide integrated care for patients with chronic conditions who require care from both primary physicians and hospitals. Effective coordination of this care can result in better outcomes and lower costs.
2) Integrated delivery systems (IDS) that provide coordinated, team-based care show promise in improving quality of care and health outcomes, especially for patients with chronic conditions. The Veterans Health Administration and Kaiser Permanente are cited as examples of high performing IDS models.
3) Evidence suggests that use of elements of the Chronic Care Model, such as patient registries, self
The document discusses several key points about palliative care:
1) Palliative care aims to relieve suffering and improve quality of life for patients with advanced illnesses alongside medical treatment.
2) Two studies found that early palliative care led to improved quality of life and mood, less aggressive end-of-life care, and longer survival times for cancer patients.
3) A study of Medicaid patients found that palliative care consultations reduced hospital costs without reducing quality of care.
Ader et al (2015) The Medical Home and Integrated Behavioral Health Advancing...Ben Miller
This document discusses recommendations for advancing the integration of behavioral health and primary care. It recommends:
1. Building demonstration projects to test integrated care approaches and evaluate them using standardized measures.
2. Developing training programs for integrated care teams, which typically include the patient, primary care provider, behavioral health specialist, and care manager.
3. Implementing population-based strategies to improve behavioral health and strengthen relationships between practices and community resources.
Michael heffer interprofessional collaborationLornestar
This document discusses interprofessional collaboration (IPC) and provides examples from St. Joseph's Health Centre of how IPC has been implemented. Some key points:
1) IPC involves intentional learning with, from, and about other professions to improve individual and team capacity and patient outcomes.
2) Government support through initiatives like funding academic health science centres has helped establish IPC. Hospitals also need senior leadership buy-in and dedicated roles to promote IPC.
3) St. Joseph's has implemented structures like an interprofessional advisory committee and point of care teams to facilitate IPC. Change leaders and competency frameworks also support its adoption.
4) Evaluating initiatives like St. Joseph
This document provides an overview and introduction to palliative care. It discusses that palliative care focuses on relieving pain, symptoms and stress of serious illness to improve quality of life. Palliative care is delivered by an interdisciplinary team and can be provided at any stage of a serious illness alongside curative treatments. The document summarizes research finding that palliative care can reduce costs by lowering hospitalizations and emergency visits while improving quality outcomes like symptoms and satisfaction. It also outlines strategies some health payers and organizations are taking to integrate palliative care, like targeting high-risk patients, dedicating case management resources and reimbursing providers.
This document discusses integrated primary care models for delivering behavioral health services. It reviews literature showing that treating behavioral health disorders can reduce overall healthcare costs. While most people receive mental health care from primary care physicians, integrated models aim to better coordinate behavioral health specialists with primary care teams. The document explores a variety of integrated models and the roles of behavioral health consultants in providing brief, targeted interventions to support primary care providers in treating behavioral health issues.
An Interprofessional Approach to Substance Abuse in Primary CareASAMPUBS
An integrated model of treatment improves care by recognizing that patients need clear and consistent care from their primary care provider “in a way that thoroughly considers biological, social, behavioral, and psychological components of their presenting complaint” by integrating psychological, addiction, and other treatments into a cohesive whole.
This document discusses collaborative practice in healthcare. It defines collaborative practice as developing effective working relationships between practitioners, patients, and communities to improve health outcomes. The benefits of collaborative practice include better patient care and health outcomes, increased job satisfaction and productivity, and a more sustainable and cost-effective healthcare system. Studies show collaborative practices between physicians and other healthcare providers can decrease hospitalizations, lower health metrics like blood pressure, and improve patient symptoms. The document outlines steps to implement collaborative practice through clarifying roles, improving communication, and assessing practices using tools like the Queen's University Collaborative Practice Assessment Tool. It stresses the importance of clear roles and accountability to reduce liability risks.
Design Research and Healthcare Reform - Mayo Clinic ProceedingsChristine Chastain
This document describes research conducted in Austin, Minnesota to understand community health needs and inform the design of a new healthcare delivery system using a patient-centered approach. Mixed qualitative and quantitative methods were used, including surveys of 487 community members. The research found significant disparities between English and Spanish-speaking residents in areas like income, education, employment, health insurance coverage, and access to care. These disparities represent barriers to achieving the goals of improved health outcomes and lower costs. The researchers conclude that effective healthcare system design should focus on creating health rather than just healthcare, and should be informed by deep understanding of community needs and context gained through design research methods.
Dr. Edward Wagner, Director (Emeritus) MacColl Center, Senior Investigator, Group Health Research Institute addresses the 2014 Weitzman Symposium on The Future of Primary Care
This document summarizes the final report from the Forum on Teamworking in Primary Healthcare. The forum was convened by several national healthcare organizations to examine teamworking in primary care. The report found evidence that effective teamwork occurs when roles are clearly defined and rewarding, communication is good, and there are shared goals. It identified barriers like competing demands, status differences, and lack of resources. The report provides recommendations to improve teamworking at both the organizational and team member levels. It also highlights several examples of successful teamworking initiatives in UK primary care settings.
Kingley Health has developed an integrated healthcare model to more effectively treat chronic lifestyle diseases like obesity. It reorganizes traditional components like primary physicians and specialists under Wellness Advisors to provide coordinated care. This improves clinical outcomes and compliance rates compared to the fragmented status quo. Kingley Health also aims to enhance the customer experience through shorter wait times and a supportive environment. Financially, its model generates more revenue per visit than typical practices by billing each service separately while presenting an integrated experience to patients. The document outlines how Kingley Health addresses limitations of the current U.S. healthcare system in managing chronic conditions.
The document discusses the future of nursing and healthcare. It outlines challenges facing the US healthcare system including rising costs and access issues. It also discusses challenges and opportunities for nursing including an aging population, need for higher levels of education, and calls to expand nursing's leadership role. The IOM report on nursing recommends increasing the proportion of nurses with bachelor's degrees and doubling the number with doctorates by 2020 to help transform the healthcare system and improve outcomes.
The document discusses key questions around the healthcare business model in the 21st century UK. It questions who the customers are for social enterprises and what constitutes an effective healthcare business model. It explores issues like personalization of care, fully engaging patients, and the challenge of relating needs to markets within a shared risk framework. The central problem addressed is how to develop sustainable business and service models that work with customers to meet their needs through innovative and authentic approaches.
The document provides an overview of the NCQA PCMH 2011 standards and guidelines, outlining the six standards, key elements and factors, requirements around must pass elements and meaningful use, and the process for practices to complete a self-assessment and apply for recognition. It also discusses the benefits of achieving PCMH recognition and the multiple efforts supporting primary care practices through the transformation process.
This document proposes an "asset-based" approach to reforming the UK's National Health Service (NHS) that recognizes patients and frontline staff as underutilized assets. It argues the prevailing consumer model views patients only as recipients of healthcare products and services, ignoring opportunities for greater participation. An asset-based approach like "co-production", used in the US, could engage patients and communities to help address structural problems in the NHS and curb rising costs from passive, deferential relationships between providers and recipients of care.
The document provides an overview of McKesson Corporation's presentation to investors. It includes the following key points:
1) McKesson has a comprehensive offering of pharmaceutical, medical-surgical, and healthcare IT products and services. It is a leader in various healthcare sectors.
2) McKesson's vision is to build strong relationships and create solutions that address the major trends in healthcare including rising drug consumption, a focus on technology and patient safety, and controlling costs.
3) McKesson's FY04 financial results showed revenue growth of 22% and EPS growth of 16%. Goals for FY05 include continued revenue and profitability growth across business segments.
Zimbabwe Independ Professional AdvocacyGEORGE MURENA
ZIPA-PHCP Advocacy Service aims to offer Zimbabwean people the opportunity to express their own needs and wishes and have these respected. By helping people to make informed choices we enable them to maintain as much control as possible over their own lives.
McKesson is a leading healthcare company focused on improving the healthcare system. It aims to deliver higher quality care at lower costs through its core businesses of pharmaceutical and medical-surgical supply distribution, healthcare IT, automation technologies, and services. McKesson touches all aspects of healthcare delivery through its network of customers including pharmacies, hospitals, physicians, and manufacturers. The company is guided by its values of integrity, customer focus, accountability, respect, and excellence.
The National Council has played a leading role in advocating for policies and practices that break down barriers to integration and collaboration, developing clinical and business models that support seamless and comprehensive healthcare, and fostering collaborative opportunities. Advocating for funds to bring primary care services to behavioral health organizations has been a National Council legislative priority. We've also been active on the practice improvement front and have helped member organizations and their primary care partners overcome clinical, cultural, and communication barriers to collaboratively provide comprehensive healthcare.
Overcoming Challenges in implementation of Quality Process in Healthcare By D...Healthcare consultant
Research has shown that 95 percent of diets fail over the long term. Oddly enough, various studies show that 60 to 80 percent of major change initiatives also fail. In both cases, it is certainly not for lack of good intentions. For a person who has been on a successful diet, it is frustrating to see those pounds sneak back on. And it is just as frustrating for an organization which has implemented a major improvement initiative to have costs, errors or inefficiencies creep in again. This is the short-term-gain, long-term-wane syndrome.
Patient Centered Medical home talk at WVUPaul Grundy
To employers the cost of healthcare is now a business issue and this talk is about what one large buyer IBM did to drive transformation via broad coalition with other large employers to form the Patient Centered Medical Home movement and the covenant between buyer and provider away from the garbage we now buy episodic uncoordinated disintegrated care. In the change of convenient conversation we have worked with the Primary care providers to give us coordinated, integrated, accessible and compressive care with a set of principles know as the Patient centered medical home.
A Patient Centered Medical Home (PCMH) happens when primary care healers keeping that core healing relationship with their patients step up to become specialists in Family and Community Medicine. The move is to the discipline of leading a team that delivers population health management, patent centered prevention, care that is coordination, comprehensive accessible 24/7 and integrated across a deliver system. PCMH happens when the specialists in Family and Community Medicine wake up every morning and ask the question how will my team improve the health of my community today?
All over the world three huge factors are in play that is driving the concept of Patient Centered Medical Home. They are:
1) Cost and demography
2) Information technology and data (information that is actionable will equal a demand for accountability by the payer or buyer of the care)
3) Consumer demand to engage healthcare differently (at least as well as they can their bank- on line) have a question about lab results why not e-mail?
But at its core it is a move toward integration of a healing relationship in primary care and population management all at the point of care with the tools to do just that.
Chocking the Barriers to Change in Healthcare System.By.Dr.Mahboob ali khan Phd Healthcare consultant
Change is undeniably hard, whether the subject is weight control for an individual or “wait control” in the emergency department. But even though it is easy to come up with excuses for allowing diets or change initiatives to slide, there are measurable rewards for adopting an approach that allows a person or an institution to set the right targets, achieve those goals and stay on track.
The document discusses the patient-centered medical home (PCMH) model for healthcare delivery. It defines key principles of the PCMH model, including having a personal primary care physician, care coordination by an interdisciplinary team, and a focus on comprehensive, high-quality care. The document argues that the PCMH model should be adopted now because the current healthcare system is broken and unsustainable due to rising costs and quality issues. It also outlines how various stakeholders could benefit from the PCMH model through things like improved health outcomes, reduced costs, and enhanced care coordination.
Drhatemelbitar (1)MEDICAL CASE MANAGEMENTد حاتم البيطارد حاتم البيطار
1. The document discusses issues with the current healthcare system including lack of coordination between institutions, dehumanization of care, and rising costs.
2. It introduces case management as a promising solution, defined as a method that aims for continuity of services and quality clinical outcomes through efficient management of available resources for specific clientele.
3. Case management relies on thorough knowledge of client needs, estimating patient stay lengths, and planning coordinated treatment processes to improve care quality while controlling costs.
United Health Group [PDF Document] Summary Annual Report (452k)finance3
This document is the 2005 annual report from UnitedHealth Group. It contains the Chairman's letter which discusses UnitedHealth Group's position and capabilities to drive change in the U.S. healthcare system through expanding access, promoting quality, simplifying services, and reducing costs. The letter highlights businesses like Ovations that address the needs of older Americans, and capabilities in data analysis, technology, and clinical administration that can help improve healthcare delivery and decision making. It expresses a commitment to making basic healthcare available to all Americans and outlines priorities going forward around issues like consumerism, provider services, technology applications, and support for uninsured individuals.
The document discusses the Obama administration's initiative to transition Medicare payments away from traditional fee-for-service models and toward alternative payment models that make providers financially responsible for quality outcomes. It argues that this transition is important for bending the health care cost curve in a politically acceptable way. The author then outlines several key success factors for providers to successfully transition to alternative payment models based on their 25 years of experience, including the robust use of accurate data, a willingness to review medical records to ensure data integrity, an ongoing commitment to changing practice patterns, and understanding how to effectively communicate the need for change to both practitioners and organizational leaders who fund health care.
This document discusses the promise of population health management (PHM) to improve healthcare in the United States. It outlines some of the key challenges with the current system, including a declining primary care workforce, fragmentation of care, and a lack of focus on prevention. The document then defines PHM and some of its core aspects, such as organized systems of care, care teams, and a focus on both medical and lifestyle factors that influence health. It also discusses some of the obstacles to implementing PHM, including the fee-for-service payment system and lack of health IT use. The document argues that new models like accountable care organizations and the patient-centered medical home show promise for enabling PHM and overcoming some of the current
This document discusses strategies for engaging healthcare providers in disease management programs when they are also participants, or "members", of those programs. It notes some challenges like maintaining boundaries and roles when providers interact with colleagues. Some effective strategies identified include acknowledging the provider-member's background, allowing input on care plans, using evidence-based guidelines, and having clinical representatives conduct informational sessions for provider-members. Peer support from other provider-members is also suggested. Training and clear communication are important to properly manage these dual provider-member relationships.
This document discusses strategies for engaging healthcare providers in disease management programs when they are also participants, or "members", of those programs. It notes some challenges like maintaining boundaries and roles when providers interact with colleagues. Some effective strategies identified include acknowledging the provider-member's background, allowing input on care plans, using evidence-based guidelines, and having clinical representatives conduct informational sessions for provider-members. Peer support from other provider-members is also suggested. Training and clear communication are important to properly manage these dual provider-member relationships.
In July 2018, NITI Aayog published a Strategy and Approach document on the National Health Stack. The document underscored the need for Universal Health Coverage (UHC) and laid down the technology framework for implementing the Ayushman Bharat programme which is meant to provide UHC to the bottom 500 million of the country. While the Health Stack provides a technological backbone for delivering affordable healthcare to all Indians, we, at iSPIRT, believe that it has the potential to go beyond that and to completely transform the healthcare ecosystem in the country. We are indeed headed for a health leapfrog in India! Over the last few months, we have worked extensively to understand the current challenges in the industry as well as the role and design of individual components of the Health Stack. In this post, we elaborate on the leapfrog that will be enabled by blending this technology with care delivery.
This document provides an overview of a study on implementing total quality management (TQM) in the healthcare sector in India. It includes an abstract that describes the rising costs and pressures in healthcare that have led organizations to adopt quality management approaches like TQM. The introduction discusses issues in healthcare quality and the need for reforms. The document then proposes a model for TQM implementation that identifies key factors like leadership, momentum, teamwork, training, focus on core processes, and measures.
The document discusses New York State's efforts to promote the patient-centered medical home model. It notes that while New York spends a lot on healthcare, the quality and health outcomes are only middle of the pack. The Commissioner of Health believes the PCMH model can help strengthen primary care, improve chronic care management, and reduce avoidable costs. New York has promoted multipayer PCMH initiatives through legislation and programs. Initial PCMH pilot programs showed promising results, and the state has seen significant uptake of PCMH recognition across practices. Evaluations are still early, but results so far are encouraging regarding patient experience and quality measures.
This document discusses the history and importance of shared governance in nursing. It began in the 1970-80s as a way to give nurses more autonomy and input in decisions. Shared governance provides infrastructure for high-quality care and allows nurses to have a voice in areas like staffing and resources. It improves outcomes and job satisfaction. During the COVID-19 pandemic, shared governance structures proved valuable by facilitating quick responses and policy changes. Professional governance takes this further by ensuring nursing control over practice, competence, quality and knowledge generation.
Co-located or embedded case management is a critical component of value-based care. The role of case managers has changed significantly over the past 25 years as the healthcare system has shifted from fee-for-service to value-based. Case managers are now seen as integral members of care teams in primary care offices, hospitals, and other settings. Having case managers embedded directly in these settings, rather than just co-located, has been shown to lead to more successful programs and better patient outcomes. As value-based programs and medical home models have expanded, the need for embedded case managers has grown substantially.
Population Health Management White Paper, Spring 2015Edward Pierce
Population health management (PHM) aims to improve health outcomes for groups of individuals through coordinated care and patient engagement. Key components of PHM include leadership from primary care physicians to develop customized care plans for each patient. Data analysis is used to identify at-risk patients and care gaps, while automation and technology help disseminate information to patients. Referral networks and payment structures incentivize physicians to focus on outcomes over volume. Hospitals are developing PHM strategies starting with their own employees to coordinate benefits, replicate the model, and expand it community-wide to improve affordability.
Imagine a healthcare system where people live long, healthy lives, receiving quality, affordable care, with clinicians nationwide collaborating to improve outcomes. That's Accountable Care! Learn the benefits of becoming an ACO in this insightful eBook.
The document summarizes a team's proposal on universal access to primary health care. The team details their coordinator, members, and contact information. It then discusses definitions of primary health care, principles of PHC, services offered at health centers, strategies to improve quality PHC according to WHO, requirements for universal access, and proposed solutions focusing on patient-provider relationships and comprehensive, equitable care.
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.
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.
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 document summarizes a presentation by Paul Grundy on extracting value from the patient centered medical home model. It discusses:
1) How the patient centered medical home model creates partnerships across the healthcare system to drive primary care redesign, offer population health management, and move away from an episodic, fee-for-service model.
2) Studies that show improvements in costs, quality, access, and utilization from implementing the patient centered medical home model, including reduced hospital and ER use.
3) How payment models are shifting towards value-based purchasing tied to quality, utilization, and patient satisfaction outcomes rather than volume of services.
This document provides a summary of evidence on the impact of patient-centered medical homes (PCMHs) and primary care innovations on cost and quality from 2013-2014. It finds that PCMH interventions are associated with modest improvements in quality of care and reductions in utilization and costs. It also discusses challenges in evaluating PCMHs and outlines opportunities to further integrate primary care with other specialties and engage consumers. The future of the PCMH relies on continued financial support, training interprofessional teams, harnessing technology, and partnering with patients and communities.
This document discusses the patient-centered medical home (PCMH) model and its benefits. It provides examples of how the PCMH approach coordinates care through a team-based approach focused on managing patient populations, uses data to drive decisions and improve outcomes, and shifts care away from episodic visits to proactive health management. Studies show the PCMH approach can reduce costs through lower utilization of emergency rooms, hospitals, and specialty care while improving quality of care and patient outcomes.
- The document summarizes the benefits of implementing a patient-centered medical home (PCMH) model, including reduced costs, improved outcomes, and better care coordination.
- Studies show PCMH practices have significantly reduced costs, especially inpatient costs, and utilization for high-risk patients. They have also improved outcomes such as reduced hospital days and emergency room visits.
- Transitioning to a PCMH model focuses on proactive, coordinated care through a team-based approach rather than episodic care during office visits. This emphasizes prevention, chronic disease management, and tracking of tests and follow-ups.
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
This document summarizes a systematic review that identified key challenges and barriers to implementing the patient-centered medical home (PCMH) model based on 28 studies from the United States. The review found six main challenges: 1) difficulties transforming practice operations and managing change, 2) implementing functional electronic health records, 3) inadequate funding and payment models, 4) insufficient practice resources and infrastructure, 5) variations in PCMH standards and accreditation, and 6) limitations in performance measures. The review concludes that understanding these challenges is important for Australian health reforms considering adopting PCMH elements.
"'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
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
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.
The document discusses the patient centered medical home (PCMH) model for improving healthcare quality and reducing costs. It provides examples of PCMH programs that have led to reductions in hospital and ER use, increased medication adherence, and lower overall healthcare costs. The PCMH model emphasizes coordinated, team-based care centered around the patient.
Care by design magill retrospective mixed methods analysis sep 21 2011Paul Grundy
This document summarizes a mixed methods analysis of practice transformation at the University of Utah Community Clinics from 2003-2009. Key elements of the transformation included implementing care teams with expanded medical assistant roles, standardized schedules, and pre-visit planning. Both qualitative and quantitative data were collected through surveys, interviews, observations and clinical/operational data. Preliminary results found improved quality measures, patient satisfaction, and access associated with higher levels of transformation implementation. Future analysis will link data on implementation, clinical outcomes, operations and costs to assess total impact on care delivery and costs. Challenges included coordinating multi-method research and navigating approvals for clinical and claims data.
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.
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.
Philippine Edukasyong Pantahanan at Pangkabuhayan (EPP) CurriculumMJDuyan
(𝐓𝐋𝐄 𝟏𝟎𝟎) (𝐋𝐞𝐬𝐬𝐨𝐧 𝟏)-𝐏𝐫𝐞𝐥𝐢𝐦𝐬
𝐃𝐢𝐬𝐜𝐮𝐬𝐬 𝐭𝐡𝐞 𝐄𝐏𝐏 𝐂𝐮𝐫𝐫𝐢𝐜𝐮𝐥𝐮𝐦 𝐢𝐧 𝐭𝐡𝐞 𝐏𝐡𝐢𝐥𝐢𝐩𝐩𝐢𝐧𝐞𝐬:
- Understand the goals and objectives of the Edukasyong Pantahanan at Pangkabuhayan (EPP) curriculum, recognizing its importance in fostering practical life skills and values among students. Students will also be able to identify the key components and subjects covered, such as agriculture, home economics, industrial arts, and information and communication technology.
𝐄𝐱𝐩𝐥𝐚𝐢𝐧 𝐭𝐡𝐞 𝐍𝐚𝐭𝐮𝐫𝐞 𝐚𝐧𝐝 𝐒𝐜𝐨𝐩𝐞 𝐨𝐟 𝐚𝐧 𝐄𝐧𝐭𝐫𝐞𝐩𝐫𝐞𝐧𝐞𝐮𝐫:
-Define entrepreneurship, distinguishing it from general business activities by emphasizing its focus on innovation, risk-taking, and value creation. Students will describe the characteristics and traits of successful entrepreneurs, including their roles and responsibilities, and discuss the broader economic and social impacts of entrepreneurial activities on both local and global scales.
Andreas Schleicher presents PISA 2022 Volume III - Creative Thinking - 18 Jun...EduSkills OECD
Andreas Schleicher, Director of Education and Skills at the OECD presents at the launch of PISA 2022 Volume III - Creative Minds, Creative Schools on 18 June 2024.
This presentation was provided by Rebecca Benner, Ph.D., of the American Society of Anesthesiologists, for the second session of NISO's 2024 Training Series "DEIA in the Scholarly Landscape." Session Two: 'Expanding Pathways to Publishing Careers,' was held June 13, 2024.
Beyond Degrees - Empowering the Workforce in the Context of Skills-First.pptxEduSkills OECD
Iván Bornacelly, Policy Analyst at the OECD Centre for Skills, OECD, presents at the webinar 'Tackling job market gaps with a skills-first approach' on 12 June 2024
This document provides an overview of wound healing, its functions, stages, mechanisms, factors affecting it, and complications.
A wound is a break in the integrity of the skin or tissues, which may be associated with disruption of the structure and function.
Healing is the body’s response to injury in an attempt to restore normal structure and functions.
Healing can occur in two ways: Regeneration and Repair
There are 4 phases of wound healing: hemostasis, inflammation, proliferation, and remodeling. This document also describes the mechanism of wound healing. Factors that affect healing include infection, uncontrolled diabetes, poor nutrition, age, anemia, the presence of foreign bodies, etc.
Complications of wound healing like infection, hyperpigmentation of scar, contractures, and keloid formation.
1. IBM Global Business Services
IBM Institute for Business Value
Healthcare and
Life Sciences
Patient-centered
medical home
What, why and how?
2. IBM Institute for Business Value
IBM Global Business Services, through the IBM Institute for Business
Value, develops fact-based strategic insights for senior executives around
critical public and private sector issues. This executive brief is based on
an in-depth study by the Institute’s research team. It is part of an ongoing
commitment by IBM Global Business Services to provide analysis and
viewpoints that help companies realize business value. You may contact
the authors or send an e-mail to iibv@us.ibm.com for more information.
3. Patient-centered medical home
What, why and how?
By Jim Adams, Paul Grundy, MD, Martin S. Kohn, MD and Edgar L. Mounib
The patient-centered medical home (PCMH) can serve as a foundation
for transformation of the U.S. healthcare system – if appropriately
conceived and properly implemented. But it can also suffer from unfettered
expectations. This study makes the realistic case for why and how
stakeholders can participate in PCMH initiatives, identifies critical issues
and makes recommendations for best practices to increase the likelihood
of initial success and sustainability.
Replacing poorly coordinated, acute-focused, A set of principles guide the development
episodic care with coordinated, proactive, and implementation of the medical home. At
preventive, acute, chronic, long-term and the core of the medical home is the patient’s
end-of-life care is foundational to the trans- active, personal, comprehensive, long-term
formation of the U.S. healthcare system. relationship with a PCP This PCP is often a
.
Many believe this can be best accomplished physician specializing in primary care, but
by strengthening primary care and having also could be a physician specialist for the
primary care provider-led (PCP) care delivery dominant condition affecting the patient or, in
teams working at the “top of their licenses” jurisdictions where they are allowed to practice
– at the level for which they are qualified independently, a nurse practitioner. Another key
and licensed. One approach to transforming principle of the PCMH is the team approach
primary care is the patient-centered medical to care. Quality and safety, combined with
home (PCMH), or the “medical home” – an care coordination, whole-person orientation
enhanced primary-care model that provides and appropriate reimbursement, represent
comprehensive and timely care with additional principles of the PCMH. Further,
appropriate reimbursement, emphasizing the patients benefit from enhanced access such
central role of teamwork and engagement by as more flexible scheduling and communi-
those receiving care. cation channels.
1 Patient-centered medical home
4. While medical homes can be a cornerstone A significant transformation of the U.S.
of transformation, they are not a “silver bullet.” healthcare system appears imminent,
They hold a great deal of promise, but many including investments in prevention – which
more supportive measures need to be should be a basis of primary care and the
undertaken to fully realize the benefits. For PCMH. Medical homes can be created now
example, steps needed for full implementation as part of this transformation. Early medical
include improved access to patient information home pilots have demonstrated success in
and clinical knowledge to improve prevention, key areas such as improved quality, greater
diagnosis and treatment; changes on the patient compliance and more effective use
part of other stakeholders (consumers, other of healthcare services. Plus, interest and
physicians, hospitals, health plans, employers, support are growing for the medical home
governments and such life sciences as model across the healthcare and life sciences
pharmaceuticals); and a robust infrastructure landscape. From a financial perspective,
to support comprehensive, coordinated care. incentives are in place to help PCPs transform
their practices.
Benefits, however, may come at a cost.
All stakeholders face possibly difficult Medical homes hold great promise – and
changes and might have to make significant many initiatives are currently in progress. Even
compromises. Even so, the alternatives could so, attempts with even the purest motives can
be even less desirable. Status quo is not fail because of unrealistic expectations, poor
an option, so stakeholders should actively planning or poor implementations. Fortunately,
participate in collaboratively shaping a more best practices are emerging that help to deal
affordable, sustainable, high-valued healthcare with these issues. Appropriately applying these
system. practices can help increase the likelihood of
success for an initial rollout and a sustainable
model. To help frame discussions and provide
guidance in utilizing current best practices
when implementing a medical home, we offer
observations and recommendations to guide
current and future initiatives.
22 IBM Global Business Services
IBM Global Business Services
5. Patient-centered medical home
What, why and how?
The current emphasis Cost, quality and access issues take to easily incorporate existing evidence into
in U.S. healthcare is toll on U.S. healthcare system practice (for example, electronic health records
The United States is struggling to address with robust decision support capabilities). The
on reactive care, not
increasing costs, poor or inconsistent quality challenges entailed in resolving these issues
prevention, wellness or 1 are daunting. Many believe success will be
and inaccessibility to timely care. Healthcare
coordination of chronic expenditures per capita are 2.4 times higher fully achieved only through a fundamental
6
conditions. than that of other developed countries and transformation of healthcare. This transfor-
are projected to increase 67 percent over
.9 mation will require that high-value, affordable
2
the next ten years. Access concerns, such health promotion and healthcare be delivered
as the 45.7 million uninsured U.S citizens (15.3 comprehensively to, and collaboratively with,
percent of total population) are taking a toll activated consumers through new delivery
7
3
on the healthcare system. Moreover, these models.
challenges are exacerbated by forces that
Key to this transformation is strengthening
are challenging the status quo: globalization,
the primary care system by replacing poorly
consumerism, changing demographics and
coordinated episodic care with a PCP-led
lifestyles, diseases that are more expensive
care delivery team working at the “top of
to treat (for example, the rising incidence
their licenses” and providing coordinated
of chronic disease) and the proliferation
engagement of individuals in their preventive,
of medical technologies and treatments.
4 acute, chronic, long-term and end-of-life care.
The current state is unsustainable. As U.S.
There is ample evidence demonstrating the
President Barack Obama stated, “…the cost
importance of primary care. Residents in U.S.
of our healthcare has weighed down our
states with higher ratios of PCPs report better
economy and the conscience of our nation
health and better outcomes. For example, they
long enough. So let there be no doubt:
experience decreased mortality from cancer,
healthcare reform cannot wait, it must not wait,
5 heart disease and stroke than persons in
and it will not wait another year.”
states with lower PCP ratios. Increasing the
U.S. healthcare is geared to treating and number of PCPs is also associated with a
rewarding acute, episodic interventions. As a longer life expectancy and fewer premature
8
result, the emphasis is on reactive care, not deaths.
on prevention and wellness or care coordi-
Although a majority of patients prefer to seek
nation for chronic conditions or serious acute
their initial care from a PCP rather than a
conditions. Poor communication exists among
specialist, there is growing dissatisfaction with
providers, as well as inadequate activation of
the healthcare system, access to primary
individuals in ownership for their own health
care and the quality of healthcare services
through education and self management. 9
received. In a national evaluation of primary
Providers have also been slow to implement
care and specialist physician performance for
evidence-based medicine in their practice
30 medical conditions plus preventive care,
workflows, in part because of the lack of
patients received recommended care only 55
evidence and the tools and support necessary 10
percent of the time. And a growing number of
patients report difficulties in scheduling timely
appointments with their PCPs.
3 Patient-centered medical home
6. In turn, many PCPs are also growing frustrated The growing level of frustration and
with the type of care they provide, as they are reimbursement discrepancy is contributing to
faced with a payment structure that rewards a widening shortage of primary care providers
acute, episodic and procedure-based care in the United States. From 1999 to 2009, 46
with insufficient reimbursement for coordi- percent fewer U.S. medical school graduates
nation and proactive, planned care. They are entered family practice residencies (see
14
typically overburdened by large numbers Figure 1). And the estimated overall primary
of short patient visits for acute problems care physician shortage is expected to reach
15
without the organization and staff needed 35,000-44,000 by 2025. Moreover, many
to proactively manage the health needs of nurses and nurse practitioners are electing to
a defined population of persons. One study work at wealthier specialty practices, further
estimates that a typical primary care physician straining the primary care system.
would need 18 hours per day, using the
current acute care visit model, to provide all Other stakeholders are becoming increas-
recommended preventive and chronic care ingly aware of the pitfalls in the primary care
11
services to a typical panel. Forty-one percent system. U.S. employers, which provide health
of the primary care workload (arranging insurance to 60.9 percent of the nonelderly
referrals, patient communication, emotional population, are increasingly dissatisfied with
support and encouragement, etc.) is not the cost and quality of healthcare services
reimbursed by a procedure/examination- they purchase and view the shortcomings in
oriented fee-for-service methodology.
12 the primary care system as key reasons why
Furthermore, the median income for they cannot buy comprehensive care for their
16
primary care physicians is about half that of employees. The cost of healthcare negatively
13
specialists.
FIGURE 1.
Family medicine residency positions and number filled by U.S. medical school graduates.
3500
3000
Positions available
2500
2000
Positions filled by U.S. graduates
1500
1000
500
0
1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
Source: American Academy of Family Physicians, based on data from the National Resident Matching Program.
4 IBM Global Business Services
7. The cost of healthcare is impacts the global competitiveness of In summary, we believe the U.S. healthcare
American companies. Poorly managed chronic system is broken and unsustainable. Primary
increasingly pushed onto
disease affects productivity, due in part to the care, a critical piece of any healthcare system,
the patient through higher
absence of strong primary care resources is “the most broken.” The purpose of this study
premium contributions, and coordination. The cost of healthcare is is to analyze the patient-centered medical
co-pays and deductibles increasingly pushed onto the patient through home, or the “medical home” – an enhanced
to the point that even higher premium contributions, co-pays and care model that provides comprehensive and
well-insured patients are deductibles to the point that even well-insured timely care with appropriate reimbursement,
patients are financially threatened by serious emphasizing the central role of primary care. In
financially threatened by
illness. Health expense debt has become a particular, we explore if and why various stake-
serious illness. 17
leading cause of personal bankruptcy. The holders should consider investment in PCMH
cost of healthcare compromises the ability of initiatives. Based on knowledge gained from
governments at all levels to provide service. current PCMH efforts to date, we also offer
Employers are also increasingly concerned considerations on how to effectively define
about the effects of healthcare costs and and implement a medical home initiative.
are eliminating or reducing health benefits. Observations and recommendations on this
And there is growing recognition that insured topic are particularly timely to help avoid
Americans might not have an established unfettered expectations about its immediate
source of access to basic primary care potential – as the model is in its infancy in the
18 20
services. United States.
“Primary care, the backbone of The medical home: What is it? What
the nation’s healthcare system, is isn’t it?
In broad terms, the PCMH provides care that
at grave risk of collapse due to a is “accessible, continuous, comprehensive
dysfunctional financing and deliv- and coordinated and delivered in the context
21
of family and community.” The American
ery system.”
Academy of Pediatrics (AAP) introduced the
– American College of Physicians19
medical home concept in 1967 to improve
healthcare for children with special needs.
In 2007 the American Academy of Family
,
Physicians, the AAP the American College
,
of Physicians and the American Osteopathic
Association issued principles defining their
vision of a PCMH (see sidebar, Principles
22
of PCMH). This represents a fundamental
change from how healthcare is being
delivered today (see Figure 2).
5 Patient-centered medical home
8. FIGURE 2.
The PCMH concept advocates enhanced access to comprehensive, coordinated, evidence-based,
interdisciplinary care.
Today's care Medical home care
My patients are those who make Our patients are those who are registered in
appointments to see me our medical home
Care is determined by today’s problem and Care is determined by a proactive plan to
time available today meet health needs, with or without visits
Care varies by scheduled time and Care is standardized according to evidence-
memory or skill of the doctor based guidelines
I know I deliver high quality care because We measure our quality and make rapid
I’m well trained changes to improve it
Patients are responsible for coordinating A prepared team of professionals coordinates
their own care all patients’ care
It’s up to the patient to tell us what We track tests and consultations, and
happened to them follow-up after ED and hospital
Clinic operations center on meeting the An interdisciplinary team works at the top of
doctor’s needs our licenses to serve patients
Source: Adapted with permission from F. Daniel Duffy, MD, MACP, Senior Associate Dean for Academics, University of Oklahoma School of
Community Medicine.
and among the 25 percent who did respond,
Principles of PCMH 25
only 40 percent were correct.
• Patient-centric/personal PCP
• PCP-directed medical team Another key component of the PCMH is the
• Whole person orientation team approach to care. Under this model,
• Care is coordinated and integrated the patient is at the center of the healthcare
• Emphasis on quality and safety
experience, supported by a team of healthcare
• Enhanced access
professionals who are practicing at the “top
• Appropriate reimbursement.
of their licenses.” The physician, nurse, nurse
Source: American Academy of Family Physicians, American
Academy of Pediatrics, American College of Physicians,
practitioner, patient educator, pharmacist, as
American Osteopathic Association. Joint principles of the well as other caregivers, have new roles to
patient-centered medical home. February 2007. play in a team-based approach to care that
incorporates a shared sense of responsibility
At the core of the medical home is the for the patient’s health. Rather than being just
patient’s personal, comprehensive, long-term a resource for episodic care, the PCP-led care
relationship with the PCP Patients who have
. team assumes proactive prevention, wellness,
a PCP will incur about a third less healthcare and chronic illness care, becoming the
expenditure and will have 19 percent lower patient’s confidant, coordinator and advisor for
23
mortality. They are 7 percent more likely to all aspects of healthcare.
stop smoking and 12 percent less likely to
24
be obese. Yet today, 75 percent of recently Quality and safety are hallmarks of the
surveyed hospitalized patients were unable to medical home. Where evidence-based
name a single doctor assigned to their care – guidelines are available and implemented,
6 IBM Global Business Services
9. While PCMHs can often with the support of IT tools, PCPs will be Consumers must be willing to take more
able to deliver both more personalized and responsibility for their health and healthcare,
be foundational to
safer care. It is also about enhanced access, including changing unhealthy behaviors
transformation, they 26
such as flexible scheduling, group visits and with appropriate help. Care delivered by
are not a cure-all. use of multiple channels of communication, the medical home team must be aligned,
such as e-mail, phone, or a Web-based portal integrated and coordinated with care delivered
where patients can manage their personal by other caregivers, such as specialists, in
health record, monitor their own issues or other venues such as ambulatory surgery
make appointments. centers or hospitals. To encourage clinicians
to collaborate and operate effectively, policy
While PCMHs can be foundational to U.S. or legislative changes will be needed in areas
healthcare transformation, they are not a such as insurance coverage, reimbursement
cure-all. Much needs to be done to support (such as payment for inter-specialist commu-
PCMHs in order to implement them and fully nication needed for care coordination),
realize the benefits. First, PCPs must have and roles and responsibilities of caregivers.
better clinical information at the point of Additionally, changes in education and
service. For example, they need better access training for clinicians will be needed to better
to relevant patient information and clinical cover critical topics such as team-based
knowledge to more accurately and completely care, use of IT for access to information and
diagnose problems and deliver effective, communication, quality improvement and
evidence-based, personalized healthcare. how to incorporate evidence into practice in
Information technology help make needed non-hospital settings. Finally, the underlying
clinical information and knowledge readily infrastructure to support the PCMH model,
available. such as IT and other services, will need to be
Second, broad support and changes much more robust (see Figure 3).
are needed from other stakeholders.
FIGURE 3.
Multiple entities, such as care delivery organizations or health plans, could help support the PCMH.
Providers
Individuals
• Tools and resources for virtual
• Health/wealth planning
interdisciplinary care delivery
and management
teams
• Risk assessment
• Tools to support better
• Personal Health Records
• Health access to clinical and patient
• Connected personal
coaching information
medical devices
• Value • Tools to support cost/quality
• Trusted clinical
coaching transparency
information
• Tools or services to provide
• Collaboration tools and
coordinated, integrated care
trusted sites
• Tools to enhance access
• Benefits selection
(e-visits, telemedicine)
• Provider selection
• Tools to streamline
administrative processes
Source: IBM Global Business Services and IBM Institute for Business Value.
7 Patient-centered medical home
10. We have learned valuable lessons from Pay-for-performance (P4P) efforts have
previous approaches to address healthcare not necessarily been more successful in
cost, quality and access problems. However, improving quality of care compared to
28
none of these approaches was as compre- non-P4P practices. Nor does P4P restructure
hensive as PCMH (see Figure 4). Today, these or emphasize changes in primary care. Some
approaches continue to evolve and sometimes experts are concerned that P4P may be toxic
cause confusion by being equated with – that providers will chase the improvement in
PCMHs. For example, “disease management” measures that provide more money, ignoring
frequently operates independently from, or de-emphasizing important improvement
29
rather than integrated with, the primary care activities that do not enhance income.
practice. The Chronic Care Model, which has
strong theoretical validity, originally focused on Non-integrated managed care, when applied
chronic patients, but is now being adapted to as a cost-controlling measure, placed the
address prevention and other issues, such as primary care physician in the role of a
access and reimbursement.
27 “gatekeeper” to control access to more
expensive specialty care.” Financial incentives
FIGURE 4.
While other approaches have addressed some PCMH Principles, none has addressed them all.
Factor/Principle PCMH Non-integrated Pay for Disease Chronic care
managed care* performance management model
Purpose/focus Facilitate Ideally: cost, Meet operational Meet specific Org. framework
partnership quality; Actually: goals with management for chronic care
between PCP and control utilization financial targets for mgt and practice
patient incentives chronic disease improvement
Patient centric/ Yes No No Maybe, often Yes, for chronic
personal PCP led by actors illness
independent of
primary care
PCP directed Yes No No No Yes
medical “team”
Whole person Yes No No No Yes
orientation
Care is Yes No incentive for No incentive for Maybe Yes
coordinated and/ coordination coordination
or integrated
Emphasis on Yes, evidence- No, reduced Indirectly; Yes, particularly Yes, for chronic
quality and based and best utilization process targets for diseases illnesses
safety practice; improved rewarded rather than
outcomes outcome ones
rewarded
Enhanced access Yes No, reduced No Maybe No
access
Appropriate Yes for PCPs, Potential conflict No, still volume Partially, if No
reimbursement unclear for others in motivation driven evidence-base
used
Alignment with PCMH principle: Aligned Mixed alignment Not aligned
*Note: By “non-integrated managed care,” we refer to the form of managed care practiced in the 1980s and early 1990s that emphasized a
“gatekeeper model” with cost controls, rather than a more patient-centered focus on primary care. Most surviving forms of managed care are
more integrated and incorporate more elements of the PCMH model.
Source: IBM Global Business Services and IBM Institute for Business Value.
8 IBM Global Business Services
11. Healthcare stakeholders encouraged PCPs (or a “distant” decision Other governmental initiatives are also
maker with limited knowledge of the patient’s underway. In the Tax Relief and Healthcare
have a unique opportunity
personal situation and little-to-no focus on Act of 2006 and the Medicare Improvements
to either engage in the
quality or satisfaction metrics) to underutilize for Patients and Providers Act of 2008,
healthcare transformation services. As a result, patients perceived Congress directed the Centers for Medicare
initiatives, including managed care as restricting access. As James and Medicaid Services (CMS) to “redesign
those based on the Robinson notes in the Journal of the American the healthcare delivery system to provide
medical home, or risk Medical Association, “The strategy of giving targeted, accessible, continuous and
with one hand while taking away with the other, coordinated, family-centered care to
being left behind.
of offering consumers comprehensive benefits 33
high-need populations.” In January 2010,
while restricting access through utilization CMS will launch a three-year demonstration
review, obfuscates the workings of the system, program that will operate in rural, urban and
undermines trust between patients and PCPs, underserved areas in up to eight states. The
30
and has infuriated everyone involved.” American Recovery and Reinvestment Act of
2009 emphasizes health IT and primary care,
PCMH, in contrast, incorporates the full range 34
among other healthcare efforts.
of care, encompassing prevention, wellness,
acute, chronic and long-term care within Healthcare stakeholders have a unique
a framework of strengthened primary care opportunity to either engage in the healthcare
and provides coordination and collaboration transformation initiatives, including those
to provide appropriate care. PCMH aligns based on the medical home, or risk being
reimbursement and practice incentives to left behind. As American Academy of Family
support the provider-patient relationship. Physicians President Ted Epperly, MD, said:
Decisions will be made using best evidence “[AAFP members] must step forward now
of appropriate and cost-effective care. Access in everything we do to try to be part of
will be enhanced rather than restricted, and the solution in transforming our healthcare
quality and satisfaction will be measured and 35
system.” And Karen Ignagni, President and
reported. CEO of America’s Health Insurance Plans,
made a similar call: “All stakeholders must rise
Why should PCMH be done now? to the challenge the President has put forth to
A significant transformation of the U.S.
develop a uniquely American solution that gets
healthcare system appears imminent. The
everyone covered, restrains healthcare cost
current administration has stated it will press
growth and aligns patient care with medical
for “comprehensive” healthcare reform
31
best practices. [Health plans] are committed
legislation in 2009. Included in his 2010
to doing our share to achieve this goal and
budget proposal, President Barack Obama 36
will work closely with other stakeholders.” In
has proposed the largest investment ever in
32
short, there is a growing consensus that trans-
preventive care.
formation is needed and that the PCMH offers
potential benefits to key healthcare stake-
holders (see Figure 5).
9 Patient-centered medical home
12. FIGURE 5.
The medical home offers potential benefits to stakeholders across the healthcare ecosystem.
Stakeholder Potential benefits of the medical home
Patient/family • Help from a trusted resource to navigate healthcare system
• Empowered to make better-informed healthcare decisions
• Receive safe, effective care with compassion
• Achieve healthier outcomes collaboratively with extended care delivery team
• Improved relationship with PCP, health plan.
Primary care • Redefine patient relationship to deliver more comprehensive, coordinated care
provider • Fair compensation for PCMH services, as well as rewards for improved clinical outcomes
• Through a shift in incentives, able to more effectively provide wellness and preventative care
• Better supported to deliver quality care to patients.
Specialist • Receive higher quality referrals, with more complete documentation
• Improved focus on area of expertise without having to assume management of patient’s
primary care
• Opportunity to offset income losses by participating in financial incentives for coordination and
quality (for example, telephone consultations).
Nurse • Develop better relationship with patients
• More involvement with patient care and support (for example, patient education, behavioral
change, preventive care, proactive care planning).
Pharmacist • Participate fully in team-based care (for example, help determine medication and reasonable
formularies).
Social worker • More integrated role to address key patient needs (for example, Medicaid).
Hospital • Serve PCMH patients whose conditions may not be as severe as non-PCMH patients
• Potentially reduce admissions from patients who cannot pay
• Potentially reduce number of re-admissions, for which there may be no or reduced payment.
Health plan • Improved member and employer satisfaction
• Expend healthcare resources with less waste and greater effectiveness though coordinated,
evidence-based care.
Employer • Purchase healthcare based on value and potentially see medical cost savings
• Maintaining more present and productive workforce, in part, through improved wellness and
prevention.
Pharmaceuticals and • Improved appropriateness of and compliance with therapeutics
other life sciences • Enhanced pharmacovigilance of products, post clinical trials.
Government • Potential to improve care quality, reduce wasteful healthcare expenditures
• Address frustration with the current uncoordinated and impersonal system.
Communities and • Potential for a healthier, more productive citizenry
society • Potential to allocate dollars so that they have greater return.
Source: IBM Global Business Services and IBM Institute for Business Value.
10 IBM Global Business Services
13. Even though changes Community Care of North Carolina (CCNC)
“If the U.S. is serious about closing has also been successful. CCNC was
in the healthcare
the quality chasm, it will need a formed to reduce healthcare costs and
system are difficult
strong primary care system, which increase access and quality of the state’s
to implement, PCMH under- and uninsured population. It includes
is an initiative that requires fundamentally reforming case managers to target high-cost, high-risk
can be successfully provider payment, encouraging enrollees. In January 2009, CCNC managed
implemented now. all patients to enroll in a patient- the care of 874,000 Medicaid enrollees and
95,000 children on NC Health Choice – a free
centered medical home, and sup- or reduced-cost health insurance program for
porting physician practices that uninsured children from birth through age 18.
42
serve as medical homes with the Both external and internal evaluations of the
program have documented positive results. A
information technology and techni- recent study reported that CCNC produced
cal assistance for redesigning care cost savings of at least $160 million per
43
processes.” year. And internal analyses have also shown
improvements. An asthma program reduced
– Karen Davis, President, Commonwealth Fund37
hospital admission rates by 40 percent and a
diabetes program improved quality of care by
Why can PCMH be done now? 15 percent.
44
Despite the difficulties in making significant
changes to the healthcare system, the PCMH Moreover, this medical home-type approach
model can be implemented now. Pilots have is working outside of the United States in
demonstrated success in key areas such as countries such as Denmark, Ireland and Spain,
improved quality, greater patient compliance which have had programs in place longer.
and more effective use of healthcare
Additionally, there is growing and broad
services, such as reductions in unnecessary
interest in revamping primary care and the
or avoidable hospitalizations and use of
medical home model in the United States.
emergency rooms for primary care. And some
PCPs, hospitals, health plans, large employers,
programs report cost savings. For example, the
consumer groups, patient quality organiza-
Voice of Detroit Initiative (VODI) was medically
38 tions, labor unions and other groups have
and financially successful. From 1999-2004,
formed the Patient-Centered Primary Care
it enrolled 25,000 uninsured individuals in
39 Collaborative to advance primary care and the
Detroit. Patients were enrolled from primary
medical home model for the 100 million people
care sites, mainly emergency departments 45
40 they represent. And many of these organi-
(EDs). VODI reduced ED use by over 60
zations have directly invested in individual
percent and costs by 42 percent (from $51.2
medical home initiatives. In addition, 44 states
million in uncompensated care costs to $29.7
41
million).
11 Patient-centered medical home
14. and the District of Columbia have passed In short, with growing support from key stake-
or introduced at least 330 laws to define or holders, examples of success from which to
46
demonstrate the medical home concept. learn, and adequate financial incentives for
Minnesota, for example, has passed legislation PCPs to transform practices, the PCMH can
requiring all health plans to have medical and should be done now.
home offerings by 2011.
How should PCMH be done?
Further, the financial incentives now exist Keys to the success of medical home
for PCPs to transform their practices. New initiatives are strong leadership and a clear
payment mechanisms are being used to vision. These must be supported by strong
compensate primary care providers for guiding principles and standards, as well as
important activities, such as those related to relevant, realistic, and flexible strategic plans
chronic disease management and monitoring, and processes to help provide effective
that were not previously reimbursable. Also, direction, structure and operations. Such
the recently enacted American Recovery and strategic plans and processes have, at times
Reinvestment Act will pay physicians up to in the past, been lacking. And as one industry
$44,000 and more for meaningful use of an leader mentioned, “if you implement the
47
electronic health record (EHR). medical home wrong, you can make it more
difficult to transform healthcare system and
Finally, the technology is now “good enough” 48
even make the practice worse.”
to get initiatives started and, done correctly,
will likely scale to support larger implementa- Leaders also observed that PCPs have played
tions. For example, disease registries, portals, a prominent role where PCMH has worked.
e-prescribing capabilities and EHRs are robust That is, PCPs need to decide that the medical
enough today to get started. home is how they want to practice medicine.
FIGURE 6.
The Patient-Centered Primary Care Collaborative is comprised of broad stakeholder support and
participation. Providers
• Primary care associations (333,000 physicians)
• Associations represnting integrated delivery networks,
academic medial centers, community hsospitals (4,000)
Purchasers
• Most Fortune 500 companies
Suppliers • Many small and medium businesses
• Pharmaceutical and via local business coalitions
medical device companies • National Business Coalition on Health
• Solution providers Patient-Centered • National Business Group on Health
Primary Care • The ERISA Industry Committee
Collaborative • HR Policy Association
Consumer advocates Health plans
• Unions • Health plans including Aetna,
• Special interest groups BlueCross BlueShield Association,
The Capital District Physicians’ Health
Plan, CIGNA, Healthcare Services
Corporation, Humana, Medco, Priority
Health, Taconic IPA, UnitedHealthcare,
Source: Patient-Centered Primary Care Collaborative. WellPoint
12 IBM Global Business Services
15. Today, there is Then, other stakeholders, including local In this section, we offer considerations to
hospital systems, physician associations, local current and future medical home initiatives, to
simultaneous
employers and business coalitions, must also help frame discussions and provide guidance
underutilization of
come together in support of the PCMH. PCPs in utilizing current best practices when imple-
proven preventive must commit to making it “their” practice and menting a medical home, based on the
and protective care affecting the necessary transformation. It rarely framework presented in Figure 7 .
with overutilization of works when non-PCP stakeholders are the
initiators. What is the problem to be addressed by
expensive diagnostics
PCMH implementation?
and interventions. The National Committee for Quality Assurance The U.S. healthcare system is ripe with oppor-
(NCQA) Standards and Guidelines for tunities to improve quality, improve access or
Physician Practice Connections – Patient- reduce costs. For example, there is underuti-
Centered Medical Home (PPC-PCMH) lization of proven preventive and proactive
was frequently used as a guide for PCMH care. This is typically caused by lack of access
discussions and planning. While not perfect to primary care for many patients and, in some
and subject to further revision, many initiatives cases, lack of incentives for, or awareness of,
have decided that the PPC-PCMH is “good best practices on the part of some physicians.
enough to get us going.” The NCQA is Moreover, failure to use less costly inter-
reviewing criticism of, and suggestions for, its viewing and physical examination and relying
guidelines, as well as results of PCMH pilots. of imaging and laboratory testing results in
The organization plans to issue revisions in overutilization of expensive diagnostics and
49
2010.
FIGURE 7:
When implementing a PCMH initiative, the problem at hand helps determine the best practices for
common implementation issues.
Is our approach
What is the problem? What are common What are the best consistently aligned
implementation practices? with problem we are
issues? trying to solve?
• What cost/quality/ • Incentives to participate • Who else has addressed • Do you have…
access issue(s) are you • Members/patients our problem? - An appropriate
targeting? - What can we learn governance structure
• Initial funding
- Near, long term? from them to with the right
• Governance address our key participants?
• What are your vision,
guiding principles? • Key metrics implementation - An agreed-upon
• Payments issues? project plan and
strong project
• Practice transformation
manager?
• Technology - Capabilities to support
infrastructure the patient cohort?
• Patient attribution - Metrics to measure
• Sustainability alignment with and
progress toward
original objectives?
Source: IBM Global Business Services and IBM Institute for Business Value.
13 Patient-centered medical home
16. interventions. The former produces poor The process of identifying the exact problem
outcomes and high cost associated with to be addressed and scope of the implemen-
frequent and avoidable specialist referrals, ED tation will likely be iterative and must address
visits and hospitalizations. The latter results several implementation issues.
in high cost from unnecessary, redundant or,
even, harmful interventions that add no value What are common implementation
to healthcare outcomes. Both groups can issues and associated best practices?
benefit from the PCMH concept. All medical homes initiatives face common
implementation issues, despite differences
Deciding what problem to solve is sometimes in approach and focus. Our discussion will
obvious, depending on which group initiates examine the most common issues for which
the discussion. For example, a dominant payer best practices exist in order to help guide new
may want to create an initiative to address a or existing medical home initiatives.
specific health-related problem. If the potential
problems to be addressed are numerous, then Incentives to participate
discussions to prioritize them must include If the environment seems like a “burning
key PCPs, health plans and purchasers (e.g. platform,” or legislative mandate exists to
employers). Err on the side of being inclusive implement the PCMH model, the incentives
rather than exclusive. Sample evaluation are clear. Frequently, that is not the case, so
questions include: key participants such as PCPs, care delivery
organizations, public and private health
• Can we establish meaningful, measurable
insurers, employers and consumers must have
goals for the implementation?
adequate incentive to participate – particu-
• Can the potential solution be implemented larly in public and private partnerships – in
in a reasonable amount of time, given likely driving major change to the broken healthcare
resources available? system.
• Is the implementation likely to accomplish
As described in Figure 5 (see page 10), a
the meaningful goals and achieve key
number of potential benefits exist for all key
metrics for success?
stakeholders. But these may come at a cost –
• Is the implementation scalable? In other these key stakeholders may undergo difficult
words, can the solution realistically be changes and may have to make significant
extended beyond those participating in the compromises for “the greater good.” Even
initial roll-out? so, these changes and compromises may be
• Is the implementation sustainable after the the best alternative at this point. More experts
pilot project ends? and decision-makers – including President
Obama – are acknowledging that the current
14 IBM Global Business Services
17. Successful PCMH U.S. healthcare system is unsustainable and Second, initiatives may focus on patients with
that status quo is not an option. Also, since the multiple chronic conditions as these patients
implementation
healthcare system is badly broken, successful represent significant opportunities for quality
requires both key
transformation will likely significantly impact all improvements or cost reduction through
participants that want stakeholders. proactive, participatory care. If these potential
to collaboratively shape benefits are realized, then challenges may
In summary, potential key participants have
the future of medical occur in sustaining the level of benefits when
three choices: they can participate and help scaling to larger populations.
care and naysayers to collaboratively shape the future; they can
make sure that the key participate to “protect their turf” so that the Patients in vertically integrated financing and
concerns are voiced and U.S. healthcare system continues down an delivery systems represent a third population
addressed early in the unsustainable path, likely bringing changes for piloting. For example, Geisinger Health
that no one will want; or they can decide not System, which has the advantage of being
initiative.
to participate and let the future be shaped for both provider and payer, included a broader
them by others. A successful implementation base of patients, most of whom were covered
must include enough participants that want by the Geisinger plan for both payment and
50
to collaboratively shape the future. But, as care. Even so, most of the initial reported
well, it must also include “turf protectors” and improvements in outcomes and costs resulted
naysayers to make sure that key concerns are from patients with chronic diseases.
voiced and addressed early in the initiative.
The focus on chronic or high-utilization
Members/patients patients is not surprising. Most of the current
The patient-centered medical home serves PCMH projects are relatively new, so insuffi-
patients (the sick or those with complaints) cient time has elapsed to demonstrate benefit
and members (those who seek participation in in asymptomatic individuals other than in the
a service that provides proactive, collaborative provision of immunizations or appropriate
and coordinated care). Decisions about which assessments. The cost-effectiveness of
members or patients to include in the initial secondary prevention measures, such as
implementation are driven in large part by the screenings, counseling for weight loss or
key stakeholders participating – which PCPs, for smoking cessation, is less clear. There is
which payers or which major employers – and a point of diminishing return in performing
the ultimate goals of the initial implementation. widespread screenings for healthy or asymp-
Early initiatives have centered on one of three tomatic people. But where that point is
patient (member) populations. remains unclear. Even the evidence of cost-
effectiveness or the ability to reduce costs for
First, initiatives may focus on underserved chronic disease management is inconclusive;
populations (for example, Medicaid or the studies frequently haven’t included costs, and
uninsured) who are typically high utilizers chronic disease management covers a broad
of uncoordinated, reactive and expensive range of activities.
services, such as emergency or inpatient care.
Thus, they offer a large potential opportunity
for quality improvements and cost reductions.
The challenge is that this patient population
could be difficult to manage and may have to
rely on social workers to a greater extent than
is typically available in today’s primary care.
15 Patient-centered medical home
18. As a result, some experts voice concern that Initial funding
PCMH may not be scalable to widespread In today’s increasingly unaffordable healthcare
implementation. However, PCMH has shown its system, funding is always an issue, and
value in smaller countries, such as Denmark, creating a medical home or a PCMH initiative
that have instituted PCMH on a national basis. requires substantial investment. Properly
It is reasonable that the ultimate goal of PCMH implemented, all stakeholders will benefit.
should be widespread implementation. If it The major payers – governments, insurers
is limited to only Medicaid/uninsured and/or and employers – could see consequential
chronic disease patients, at least three adverse reductions in expenditures or improvements
effects can occur: in value over time. Under some circum-
1. A large fraction of patients will be denied stances, hospitals or healthcare systems
the advantages of PCMH. The potential can benefit both by providing improved care
benefit of involving patients before they and saving money. For example, hospitals
have established chronic disease and that treat Medicaid or the uninsured may
disability will be lost. benefit financially from the reduced utilization
associated with medical home by avoiding
2. The true value of prevention may never be
unnecessary unreimbursed or poorly
known.
reimbursed care. Organizations that are both
3. The benefit of practice transformation will a payer and provider should see financial
be blunted. benefits. Thus, all these groups have incentives
a) Practices may be confined to one group to provide initial funding for creating medical
or type of patient. homes.
b) Practices may be divided – part In fact, members of each of these groups
PCMH, part acute-care-based, leading have funded the development of PCMH
to unnecessary complication and programs. CMS provided initial funding for
confusion. medical homes and provides additional funds
c) The costs of practice transformation for initiatives. North Carolina has developed
(for example, care coordinators, a medical home for approximately 874,000
24-hour access, etc.) will not be evenly Medicaid patients and 95,000 children on NC
51
distributed. It will be reminiscent of Health Choice. Pennsylvania has developed
the conflicts between HMO patients a state program oriented to chronic care
and indemnity patients in the early patients. Among many others, the Blues in
managed-care environment. Michigan, Horizon in New Jersey and all the
health plans in Vermont have funded medical
Because of the ethical and operational home projects. IBM, as an example of one
challenges of having a divided practice – employer’s support, provides an additional
with part of the patients under the medical $12 per member per month to fund the care
52
home and part not – most provider practices management services of a medical home.
participating in medical home initiatives that Geisinger Health System implemented and
we surveyed transform their practices for all funded a patient-centered medical home
patients, not just for patients formally partici- with preliminary results showing a 7 percent
pating in the initiative. reduction in costs and a 20 percent reduction
53
in all-cause hospital admissions.
16 IBM Global Business Services
19. The governance Some pharmaceutical firms also support Medical home governance should focus on
medical home initiatives as the PCMH model strategic alignment of goals and outcomes
structure should
may result in improved appropriateness of (“What is the problem we are trying to
be inclusive of all
and long-term compliance with medicines address?” see page 13); value delivery (“How
,
relevant stakeholders by persons with chronic illness, for example. will each stakeholder contribute to deliver the
across the public and The model also offers promises for enhanced benefits promised at the beginning of a project
private sectors. prevention, so there are opportunities for or investment?”); resource management (How
improved use of vaccines. will we manage our resources and ourselves
more efficiently to meet our goals?”); risk
Governance management (“How will we measure, accept
A sound governance structure and process and manage risk?”); and key metrics (“What
are needed to align and sustain the medical are the qualitative and quantitative measures
home initiative’s strategies and objectives. The needed to assess our performance towards
goals and approach should be documented reaching our goals?”).
in a charter, and the process of transformation
should enable collective learning across Key metrics
participating stakeholders. Without this, as Measurement and evaluation processes are
one healthcare leader noted, the “messages critical because of their effects on the rewards
get blurred because everyone needs to for information sharing, the motivation for risk
54
understand what we’re doing and why?” taking, incentives for desired behaviors, the
resulting organizational learning and other
This structure should be inclusive of all factors. Educating the medical home stake-
relevant stakeholders across the public and holders on the metrics and why they may vary
private sectors, including PCPs, physician across functions is crucial for maintaining
organizations or affiliations, consumers, major morale and cooperation. To date, medical
employers, health plans and key government home efforts have used a combination of the
representatives, such as those from Medicaid following types of key metrics:
and the state insurance commission. Such
widespread participation offers great • Costs: Targeted cost metrics are impacted
advantages (greater buy-in, for example) and by things such as the types of patients, the
challenges (delays in reaching consensus) number of patients and the duration of the
– but will require flexibility, as expectations PCMH initiative.
and standards will likely evolve over time. • Process of care: Appropriate screening
Additionally, attorneys may need to attend for traditional conditions such as breast,
governance meetings to help discussions stay colorectal, and prostate cancers, for
within the bounds of prevailing laws, or guide example. Some have aligned these metrics
actions for changing or requesting exceptions with NCQA accreditation measures, thereby
to current regulations. It is also important to incenting health plans to participate and
include both zealots and the naysayers to to offer pay-for-for-performance reimburse-
allow all perspectives to be considered. ment. Other groups have also focused on
targeted conditions that are more endemic
to their population.
17 Patient-centered medical home
20. • Outcomes of care: Measurements of the Reimbursement
change in health for a patient or a cohort. Medical homes initiatives are experimenting
Since there is no definitive health index, with different payment structures, as groups
outcome measures have focused on find the right balance for stakeholders and
individual conditions and patient compli- program objectives. Today, initiatives use
ance (for example, tracking change in combinations of four basic reimbursement
glycosylated hemoglobin (HbA1c) levels in elements: fee-for-service payments with
diabetics or blood pressure for hyperten- new service codes (for example, e-visits);
sion) or utilization (for example, hospital care management fees; bonus payments for
admissions or emergency department meeting certain criteria (for example, NCQA
visits). certification); and quality or performance
56
• Service: Service metrics have focused on incentives. By far the most common
operational aspects, such as the time to approach is a traditional fee-for-service
answer the telephone and the wait until the payment and additional payment for meeting
next appointment. certain quality metrics.
• Patient and caregiver satisfaction: A key However, concerns exist about some of
way a medical home can demonstrate its these proposals. For example, some argue
commitment to quality and in improvements that retaining volume-based elements risks
is to assess the satisfaction of its patients inhibiting the necessary transformation to
and the clinicians providing care. There proactive, preventive, and non-visit coordi-
are numerous existing surveys to choose nation of care delivery and the practice. So,
from, such as Consumer Assessment of while there is no perfect model, a blended
Healthcare Providers and Systems (CAHPS), model, such as the three-part payment
which enables groups to compare their methodology recommended by the Patient-
results with national ones. Centered Primary Care Collaborative – which
• Coordination of care: These metrics are includes components for services rendered,
more innovative, but more difficult, since care management and performance – may be
57
they require a sophisticated tracking system. the best compromise.
With its consultation and referral tracking
In Colorado, for example, the Colorado
system, the University of Oklahoma is
Multi-Stakeholder Pilot has implemented
developing a set of measures that accounts
the three-tier reimbursement model of
for the rapidity of referrals and getting the
fee-for-service, per-patient-per-month and
referral, from initiation to completion, and
55
pay-for-performance that aligns with the Joint
includes quality and process measures.
Principles and the PCPCC recommenda-
So “what proportion of patients with certain 58
tions. This model mitigates the unintended
kinds of problems is seen by the specialist
consequences present when implementation
and was handled in this e-mail exchange?”
is in a siloed fashion. Nevertheless, experi-
is an example of a novel measure, tied to
mentation is key and should be directed by
the ability to track that kind of information.
18 IBM Global Business Services
21. PCPs should view the a set of guiding principles, such as the Practice transformation
ones provided by the AAFP (see sidebar, PCPs that participate in the medical home
medical home as a
AAFP’s Recommendations for Medical Home should view it as a transformation of their
practice transformation
Payment). practice that affects all of their patients, not
that affects all of their simply those active in the medical home
patients. AAFP’s Recommendations for Medical initiative. If implemented only for a few patients,
Home Payment it will require old and new processes to
According to the AAFP, the medical home payment co-exist, creating operational complexities for
structure should: the practices.
• Reflect the value of PCP and non-PCP staff
Successful transformations require a focused,
work that falls outside of the face-to-face
visit associated with patient-centered care tightly coupled approach that incorpo-
management rates systematic change management,
including the redesign of key processes and
• Pay for services associated with coordination of
capabilities across the practice, as well as
care both within a given practice and between
changes in roles and responsibilities. This
consultants, ancillary providers and community
helps the medical home team to achieve the
resources
desired goals of providing more coordinated,
• Support adoption and use of health information integrated and ongoing care, and represents
technology for quality improvement an overall change in the culture or value
• Support provision of enhanced communication system of the practice.
access, such as secure e-mail and telephone
consultations Figure 8 gives an example of the possible
impact of this transformation. The horizontal
• Recognize the value of PCP work associated
axis represents the percentage of patients in
with remote monitoring of clinical data using
this hypothetical practice needing the various
technology
services listed. The bars are color-coded to
• Allow for separate fee-for-service payments represent which medical home team member
for face-to-face visits, but payments for care- could be assigned primary responsibility for
management services that fall outside of the
that service. Obviously, these assignments
face-to-face visit, as described above, should
could vary from practice to practice depending
not result in a reduction in payments for face-to-
on factors such as the demographics of the
face visits
medical home population and the numbers
• Recognize case mix differences in the patient and types of resources and skill sets available.
population being treated within the practice Additionally, resources outside the practice
• Allow PCPs to share in savings from reduced would be available and should be used appro-
hospitalizations associated with PCP-guided priately. Also, since this would be a PCP-led
care management in the office setting interdisciplinary team, other team members
• Allow for additional payments for achieving – including the PCP – would likely assist or
measurable and continuous quality improve- support the person(s) with primary responsi-
ments.
19 Patient-centered medical home