Steven R. Peskin, MD, MBA, FACP

EVP and Chief Medical Officer,
MediMedia USA

Assistant Clinical Professor, UMDNJ




  P...
Presentation Overview

      The Need
      Key Elements of Patient Centered Medical Home
      ACP Medical Home Builde...
The Need
Average spending on health
How do you start to fix the                                      per capita ($US PPP)
foundatio...
―We do heart surgery more often than anyone, but we
need to, because patients are not given the kind of (1)
coordinated pr...
Need for a New Healthcare Delivery Model

    Increasing costs
     – Healthcare costs are growing faster than the econom...
Need for a New Healthcare Delivery Model

    Inadequate response to chronic care needs
     – Increasingly aging and chr...
Key Elements of Patient Centered
        Medical Home
A Joint Proposed Solution
The Patient-Centered Medical Home (PCMH)

     Modern ―medical home‖ concept originally in Pedi...
The Patient-Centered Medical Home

 Redesigns clinical delivery and payment to facilitate
 – Patient-centered, longitudin...
A New Model of Care that Redesigns
               the Way Primary Care is Delivered and Financed




     Patient         ...
Not Defined by any Certain Specialty




      Patient       Personal Physician
Physician as Facilitator, Not a Gatekeeper




                    Patient            Personal Physician




Specialist Ca...
(5) Changes in Clinician Incentives
                                                           Improved Patient Interactio...
Nine Core Components
        PPC 1: Access & Communication (9)
        PPC 2: Patient Tracking & Registry Functions (21)
 ...
Physician Practice Connections – PCMH Levels




                             Level 3: 75+ Points; 10/10 Must Pass



    ...
Media Attention


  Primary-care doctors and health system reformers
  are predicting that a new way of providing health
 ...
The Patient-Centered Primary Care Collaborative
          Examples of Broad Stakeholder Support & Participation

         ...
www.acponline.org/medicalhomebuilder
`
Key Characteristics
• National, credible, transparent resource
• Free for physicians and professional associations
• Abili...
Program Features
• AmericanEHRPartners.com - interactive online
  community
• Educate and enable a wide range of physician...
MOCK UP OF
     SITE


Readiness
Assessment
Comparison Tool
Auto-RFI
Implementation help
Learning network
Podcasts
...
Demonstration Projects
(Patient Centered Medical Home)




6% decrease in hospital admissions
24 % decrease emergency room
$500, Per member per y...
Horizon Blue Cross Blue Shield/Partners In Care




For the New Jersey State Health Benefits Program
Results: Clinical Process Metric Improvement

                                                       HbA1c Testing
       ...
Lewisburg      preTest period   First pilot year   Percent reduction
Pennsylvania   Jan - Oct 2006   Jan – Oct 2007

Hospi...
Marillac’s Integrated Care Patients (PCMH)




  25%
        22%
  20%
                                                   ...
Overview of PCMH Commercial
                   Pilot Activity

                             • 22 projects
                ...
Overview of PCMH Commercial
              Pilot Activity (cont.)
           Since October 2008:
                       •  ...
Initiatives to Advance Medical Homes in
                            Medicaid/ SCHIP




                                  ...
Combined Medical Home Activity
Discussion
Medical HomePresentation
Medical HomePresentation
Medical HomePresentation
Medical HomePresentation
Medical HomePresentation
Medical HomePresentation
Medical HomePresentation
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Medical HomePresentation

  1. 1. Steven R. Peskin, MD, MBA, FACP EVP and Chief Medical Officer, MediMedia USA Assistant Clinical Professor, UMDNJ Patient-Centered Primary Care Model February 9, 2010
  2. 2. Presentation Overview  The Need  Key Elements of Patient Centered Medical Home  ACP Medical Home Builder  Demonstration Projects  Discussion
  3. 3. The Need
  4. 4. Average spending on health How do you start to fix the per capita ($US PPP) foundational issue around why 7000 United States our healthcare system is so Germany expensive and yet so broken?? Canada 6000 France Australia United Kingdom 5000 4000 3000 2000 1000 0 80 82 84 86 88 90 92 94 96 98 00 02 04 19 19 19 19 19 19 19 19 19 19 20 20 20 Source: K. Davis, C. Schoen, S. Guterman, T. Shih, S. C. Schoenbaum, and I. Weinbaum, Slowing the Growth of U.S. Health Care Expenditures: What Are the Options?, The Commonwealth Fund, January 2007, updated with 2007 OECD data
  5. 5. ―We do heart surgery more often than anyone, but we need to, because patients are not given the kind of (1) coordinated primary care that would prevent chronic heart disease from becoming acute.‖ George Halverson’s (CEO Kaiser) Healthcare Reform Now
  6. 6. Need for a New Healthcare Delivery Model  Increasing costs – Healthcare costs are growing faster than the economy and the cost of care is becoming difficult for employers, government and individuals to meet.  Need to improve quality – Patients receiving recommended treatment 55 % of the time – Poor U.S. performance on healthcare benchmarks compared to other developed countries despite spending more.  Regional variation – Healthcare cost and quality vary substantially among geographic regions. Little relationship between cost and quality.
  7. 7. Need for a New Healthcare Delivery Model  Inadequate response to chronic care needs – Increasingly aging and chronically ill population with payment system that doesn’t recognize services found necessary for essential care e.g. care coordination, evidence-based population management, disease self management  Decreased Interest in Primary Care – The number of new students entering into primary care is decreasing and physicians who have chosen the field are disproportionately leaving compared to other specialties. – Both domestic and international data indicating that higher proportion of primary care physicians related to higher healthcare quality and lower costs.
  8. 8. Key Elements of Patient Centered Medical Home
  9. 9. A Joint Proposed Solution The Patient-Centered Medical Home (PCMH)  Modern ―medical home‖ concept originally in Pediatric literature in the 1960’s—a central source of care for ―Special Needs‖ children.  AAFP—Future of Family Medicine Project (2004) ―Personal Medical Home‖  ACP—Advanced Medical Home (2006)  Key elements of a PCMH are described in a March 2007 joint statement of principles from ACP, AAFP, AAP and AOA. Often referred to as the ―Joint Principles‖.  Nexus of patient-centered care, primary care and chronic care model concepts
  10. 10. The Patient-Centered Medical Home  Redesigns clinical delivery and payment to facilitate – Patient-centered, longitudinal, coordinated care delivered by a ―recognized‖ practice with a personal physician – Who accepts responsibility for the patient’s ―whole person‖ – Who acts in partnership with patients and in collaboration with multidisciplinary teams (nurses, physician specialists, health educators, pharmacists) – Who uses practice level systems to improve access and communication, care integration, patient safety and outcomes – Who accepts accountability for care provided through on-going performance measurement and quality improvement.
  11. 11. A New Model of Care that Redesigns the Way Primary Care is Delivered and Financed Patient Personal Physician  Trusted personal physician  Enhanced payment that recognizes the added value  Physician who provides, manages and facilitates care of delivering care through the PCMH model  Care is coordinated or integrated across healthcare  Assistance to practices seeking transformation system  Support to practices adopting HIT for QI  More accessible practice with increased hours and easier scheduling
  12. 12. Not Defined by any Certain Specialty Patient Personal Physician
  13. 13. Physician as Facilitator, Not a Gatekeeper Patient Personal Physician Specialist Care Pharmacist Care Hospital Care
  14. 14. (5) Changes in Clinician Incentives Improved Patient Interaction Blended Payment Better Work Environment Fee For Service  More time for patients  Fee for service  Team effort  Better communication  Prospective payment  Increased responsibility for admin and clinicians and access  Pay for outcomes  Case management Personal Physician
  15. 15. Nine Core Components PPC 1: Access & Communication (9) PPC 2: Patient Tracking & Registry Functions (21) PPC 3: Care Management (20) PPC 4: Patient Self-Management Support (6) PPC 5: Electronic Prescribing (8) PPC 6: Test Tracking (13) PPC 7: Referral Tracking (4) PPC 8: Performance Reporting & Improvement (15) PPC 9: Advanced Electronic Communication (4) TOTAL POINTS: 100
  16. 16. Physician Practice Connections – PCMH Levels Level 3: 75+ Points; 10/10 Must Pass Level 2: 50-74 Points; 10/10 Must Pass Level 1: 25-49 Points; 5/10 Must Pass
  17. 17. Media Attention Primary-care doctors and health system reformers are predicting that a new way of providing health care should provide better, cheaper results. The pay boost rewards doctors who reshape their practices to recreate an era when a trusted family The idea, called medical homes, combines physician helped patients through hospitalizations, traditional notions of family physicians with coordinated specialist care and provided routine modern technology. It has caught the attention screenings. Such efforts may save money by of medical leaders, insurance companies and reducing hospitalizations, ER visits and disease. politicians. – 7/14/2008 – 3/18/2008 Health policy experts say that unless payment and The resurgence of patient and purchaser interest practice rules are changed, the financial squeeze in primary care is leading to the support of some on primary care doctors threatens to a crisis for innovative practice models, largely outside the patient care. academic health centers. One is the patient- – 11/7/2007 centered medical home. – 04/2008
  18. 18. The Patient-Centered Primary Care Collaborative Examples of Broad Stakeholder Support & Participation Providers Purchasers – 333,000 primary care Most of the Fortune 500  ACP  AAP  IBM  General Motors  AAFP  AOA  FedEx  General Electric  ABIM  ACC  Pfizer  Microsoft  ACOI  AHA  Business Coalitions  Wal-mart  AMA The 80 Million lives Patient-Centered Medical Home Payers Patients  BCBSA  Aetna  NCQA  AFL-CIO  United  Humana  National Partnership for Women and Families  CIGNA  HCSC  Foundation for Informed  WellPoint Decision Making  SEIU
  19. 19. www.acponline.org/medicalhomebuilder
  20. 20. `
  21. 21. Key Characteristics • National, credible, transparent resource • Free for physicians and professional associations • Ability to reach doctors in small and mid-sized practices through their professional associations • Create a Learning Community for health IT • Target tools to three groups of healthcare providers – New adopters – Current users wanting to transition to a new EHR – Current users looking to optimize their EHR
  22. 22. Program Features • AmericanEHRPartners.com - interactive online community • Educate and enable a wide range of physician needs – Creation and aggregation of educational materials – Users can search, display and compare appropriate EHR solutions for their practice, specialty and certification type – User ratings (i.e. surveys, online ratings) – Verified health professionals – Automated EHR selection process for RFI submissions & vendor demonstrations – Podcasts, blogs, newsletters, EHR Readiness Assessments and other interactive tools – Data dashboards - Professional associations, organizations and physicians
  23. 23. MOCK UP OF SITE Readiness Assessment Comparison Tool Auto-RFI Implementation help Learning network Podcasts Blogs/RSS Feeds Specialty-society info Important links
  24. 24. Demonstration Projects
  25. 25. (Patient Centered Medical Home) 6% decrease in hospital admissions 24 % decrease emergency room $500, Per member per years savings
  26. 26. Horizon Blue Cross Blue Shield/Partners In Care For the New Jersey State Health Benefits Program
  27. 27. Results: Clinical Process Metric Improvement HbA1c Testing 100 91% 75 50 25 43% 0 January November 2007 2007 Permission from Horizon Blue Cross Blue Shield and Partners in Care, Corp.
  28. 28. Lewisburg preTest period First pilot year Percent reduction Pennsylvania Jan - Oct 2006 Jan – Oct 2007 Hospital 365/1000 291/1000 -20% Admission Hospital 15.2% 7.9% -48% readmissions Cost 7% less
  29. 29. Marillac’s Integrated Care Patients (PCMH) 25% 22% 20% 13% 15% 9% 10% 4% 5% 0% Year 1 Year 2 Year 3 Year 4 Year 4.5 Hospitalization E.R. Visit
  30. 30. Overview of PCMH Commercial Pilot Activity • 22 projects • 16 states • 12 are Multi-stakeholder • 10 are Insurer-based
  31. 31. Overview of PCMH Commercial Pilot Activity (cont.) Since October 2008: • Alabama New commercial • California PCMH projects • Indiana under • Maryland development in • North Carolina at least 8 more • Oklahoma • Oregon states: • West Virginia Additionally, new projects are under development in the previous states,
  32. 32. Initiatives to Advance Medical Homes in Medicaid/ SCHIP = Identified to have a medical home initiative Source: National Academy for State Health Policy State Scan, November 2008
  33. 33. Combined Medical Home Activity
  34. 34. Discussion

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