Transcript Medical Home Pictorial and Messaging

The Patient-Centered Medical Home
(PCMH):
Building a Better Health Care Model
Objectives
• Identify current priorities for health reform.
• Describe the Patient-Centered Medical
Home (PCMH) model of care.
• Understand how the PCMH model is an
appropriate vehicle to address priority
health reform issues.
• Understand Family Medicine’s role in the
development and adoption of the PatientCentered Medical Home.
Patients today are savvy
consumers of health care and have
higher expectations.
– Communication
– Access
– Convenience
– Coordination
– Responsiveness
• Source: Medfusion, an AAFP affinity partner, 2008
Patient Expectations
• 75% want the ability to interact with their
physician online (appointments, prescriptions,
test results).
• 77% want to ask questions without a visit.
• 75% want email access as part of their overall
care.
• 62% of patients say access to these services
would influence their choice of physicians.
– Source: Medfusion, an AAFP affinity partner, 2008
Family Medicine is leading the way to make health
care more patient-centered.
“Will family medicine teachers prepare their students and
residents to help practices transform and meet the
infrastructure principles? I believe that we will, not simply
because doing so will likely increase our financial
situation but because building PCMHs that meet the care
and infrastructure principles will improve the care we
provide to meet our patients’ and our communities’
needs. We will build our PCMH practices, because it is
the right thing to do and it reflects our core values.”
John C. Rogers, MD, MPH, MEd
Past-President,
Society of Teachers of Family Medicine
Fam Med 2008;40(1):11-2.)
Health Care Reform
Priorities for US health care reform include:
• Quality
– WHO (World Health Organization) identifies the US health care
system as the “most individually responsive”
– WHO ranks US health care 37th overall (among 191 countries)
• Efficiency
– People with acute and chronic medical conditions receive only
about two-thirds of the health care that they need.
– Between 20 and 30% of tests and procedures provided to
patients are neither needed nor beneficial.
*Leatherman and McCarthy, Quality of Health Care in the United States: A Chartbook, 2002. The Commonwealth Fund
*Schuster, McGlynn, and Brook, 1998
Health Care Reform
Priorities for US health care reform include:
• Cost
– The U.S. spends more on health care per capita than any other
nation.
– The U.S. spends more on health care as a proportion of GDP
(Gross Domestic Product) than any other nation.
• Patient-friendly
– Public confidence in hospitals and personal doctors remains
relatively high.
– While individuals report generally positive experience with
medical care, public confidence and trust in the system at large
is eroding.
*Leatherman and McCarthy, Quality of Health Care in the United States: A Chartbook, 2002. The Commonwealth Fund
Health Care Reform
Priorities for US health care reform include:
• Access
– Lack of insurance is a major reason for not obtaining access to needed
care.
– The 40 million Americans without insurance coverage are less likely to
obtain needed medical care and preventive tests
– Even with insurance, barriers to care still exist:
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Lack of an established relationship with a doctor
Language barriers
Cultural barriers
Transportation issues
Geography
• Automation
– Infrastructure for health care delivery has not kept pace with the
electronic innovations of other industries.
– Many institutions still rely on systems that are not automated and allow
opportunities for human error, even though technology exists to
minimize errors and improve efficiency.
An effective and efficient health
care system is a primary carebased health care system
– Provides access to basic health care services
– Manages health disparities
– Coordinates care
– Controls cost
– Offers sustainability
• www.aafp.org/valueoffamilymedicine
Innovative Solution:
History of the PCMH Concept
• Introduced by American Academy of Pediatrics (AAP) in 1967
• Initially referred to a central location for medical records
• The medical home concept was expanded in 2002 to include:
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Accessible
Continuous
Comprehensive
Family-centered
Coordinated
Compassionate
Culturally sensitive care
• In 2007, the AAP, the American Academy of Family Physicians
(AAFP), the American Osteopathic Association (AOA), and the
American College of Physicians (ACP) adopted a set of joint
principles to describe a new level of primary care.
“Joint Principles” of the
Patient-Centered Medical Home
• A personal physician who coordinates all care for
patients and leads the team.
• Physician-directed medical practice – a coordinated
team of professionals who work together to care for
patients.
• Whole person orientation – this approach is key to
providing comprehensive care.
• Coordinated care that incorporates all components of the
complex health care system.
• Quality and safety – medical practices voluntarily engage
in quality improvement activities to ensure patient safety
is always being met.
• Enhanced access to care – such as through openaccess scheduling and communication mechanisms.
• Payment – a system of reimbursement reflective of the
true value of coordinated care and innovation.
Growing Support for the PatientCentered Medical Home
• Partnerships are developing as more and more
stakeholders see value in the Joint Principles.
• The Patient Centered Primary Care Collaborative
(PCPCC) is a coalition of major employers,
consumer groups, patient quality organizations,
health plans, labor unions, hospitals, physicians
and others to develop and advance PCMH.
• The PCPCC has well over 500 members.
*www.pcpcc.net
The Patient Centered Medical Home
The Family Medicine Model
Great
Outcomes
Practice
Organization
Health IT
Quality
Measures
Heath
Health
IT
Information
Technology
Patient
Patient
Experience
Experience
Family Medicine Foundation
Patient-centered | Physician-directed
Culture of
Improvement
• Starts with a culture of
improvement
• Ensure quality
improvement initiatives
are not punitive; should not
discourage physicians from
caring for patients
Quality
Measures
Performance
Measurement
• Quality measures should be
based in strong clinical
evidence
• You can’t improve what you
don’t measure
Reliable
Systems
• Develop reliable systems
to collect information
Convenient Access
Personalized Care
Care Coordination
• Patients want convenient
access to information,
communication, and care
• Patients want to access
to care when they are ill
• Patients are engaged in their
own care and want to share
in decision-making
• Patients want increased
ability to access information
• Patients want coordinated
care
• Patients want new
approaches to care: group
visits and on-line services
Quality
Measures
Patient
Experience
Financial Management
• All staff are aware of the
most effective ways to
deliver care
• National policies support the
investment of resources into
primary care practices that
are effective and efficient
Personnel Management
• Every team member
understands the important
role they play in delivering
efficient care and is
empowered to make
suggestions for
improvement
Practice
Organization
Quality
Measures
Patient
Experience
Clinical Systems
• Lab testing
• Prescriptions
• Registries
• Lab testing
• Prescriptions
• Patient Registries
Business & Clinical
Connectivity &
Evidence-Based
Clinical Data Analysis
Process Automation
Communication
Medicine Support
& Representation
• Patient reminders
• Patient notification for
new information
• Reminders for
recommended care or
health maintenance
• Makes patient registries
possible
• Enhances care
coordination by
improving information
flow with other
physicians, practices,
and providers
• Improves patient physician communication
Practice
Organization
Health
Information
Technology
Quality
Measures
Patient
Experience
Family Medicine Foundation
• Point-of-care learning
(e.g., Up-to-Date)
• Clinical decision support
(e.g., Epocrates)
• Can quickly pull clinical
data for quality analysis
• Can enhance business
processes
Great Outcomes
• Good for patients
– Patients enjoy better health.
– Patients share in health care decisions.
• Good for physicians
Great
Outcomes
Practice
Organization
Quality
Measures
Health
Information
Technology
Patient
Experience
Family Medicine Foundation
– Physicians focus on delivering excellent
medical care.
• Good for practices
– Team works effectively together.
– Resources support the delivery of
excellent patient care.
• Good for payors and employers
– Ensures quality and efficiency.
– Avoids unnecessary costs.
The Patient Centered Medical Home
The Family Medicine Model
Great
Outcomes
Practice
Organization
Health IT
Quality
Measures
Heath
Health
IT
Information
Technology
Patient
Patient
Experience
Experience
Family Medicine Foundation
Patient-centered | Physician-directed
The PCMH Model in Action:
North Carolina Community Care Collaborative
• Asthma and diabetes initiatives were developed due to high
prevalence in the North Carolina Medicaid population.
• Care was coordinated by a primary care physician.
• Care included patient education and team collaboration.
• Initial goals focused on reducing unnecessary hospital
admissions and emergency room visits. Additional quality,
efficiency, and cost control elements were added later.
• The CCNC Asthma Program demonstrated costeffectiveness.
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34% lower hospital admission rate.
8% lower ED visit rate.
Average ED “episode” cost for children was 24% lower.
21% increase in asthma patients who have been staged.
112% increase in asthmatic patients receiving flu shots.
$3.5 million dollar savings
The PCMH Model in Action:
North Carolina Community Care Collaborative
• The CCNC diabetes initiative demonstrated
improvement in process measures and implementation
of evidence-based best practice guidelines.
– 7% increase in referrals for dilated eye exams.
– 23% increase in bi-annual foot exams.
– $2.1 million savings.
• Without any concerted efforts to control costs, the
program overall saved $60 million in 2003, $124 million
in 2004, and $231 million in 2005 and 2006.
• Almost $1 M in savings achieved during the first two
quarters of 2005 just for prescription use.
• www.communitycarenc.org
The PCMH Model in Family
Medicine Residency Training
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“Preparing the Personal Physician for Practice” (P4)
The P4 Initiative is designed to inspire and examine innovation in family
medicine residency training.
Sponsors are the American Board of Family Medicine, the Association of
Family Medicine Residency Directors, and TransforMED.
Different approaches range from moving the continuity clinic into a new
community setting, to expanding to a four-year program, to providing the
opportunity for tracking and obtaining additional degrees while in training,
and more.
The aim of P4 is to spur innovation in all family medicine residencies to best
prepare family physicians be the excellent personal physicians of tomorrow.
Initially, 84 Family Medicine residencies applied to participate in the P4
Initiative.
The 14 P4 residencies were selected as participants for more intensive
evaluation of outcomes to determine what works best.
Findings are being shared with all residencies to inspire more innovations
and change.
http://transformed.com/p4.cfm
PCMH Model and Health Care
Reform
• Attempts to fix part of the problem without
addressing it comprehensively will not lead to
viable solutions.
• Advocacy by all stakeholders is necessary.
– Community projects through local hospitals and
resource networks
– State projects for regional payors and state Medicaid
programs
– National support for changing how care is delivered
and for ensuring a prepared workforce to deliver care
Family Physicians and the PCMH
• PCMH is a place, not a person.
• Patient-centered, Physician-directed.
• Family physicians
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Provide comprehensive care
Care for all patients
Coordinate care
Provide care that is effective
and efficient*
• Future of Family Medicine
• *Starfield data
Great
Outcomes
Practice
Organization
Quality
Measures
Health
Information
Technology
Patient
Experience
Family Physicians
How we provide care:
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Acute injuries and illnesses
Health promotion and behavior change
Hospital care
Chronic disease management
Maternity care
Well-child care and child development
Primary mental health care
Supportive and end-of-life care
Family Physicians
How we view patients:
• Consider all of the influences on a person’s
health.
• Know and understand people’s limitations,
problems, and personal beliefs when deciding
on a treatment.
• Are appropriate and efficient in proposing
therapies and interventions.
• Develop rewarding relationships with patients.
• Provide a continuous healing relationship over
time.
Family Physicians
Who we care for:
• Individuals and families
• Women and men regardless of age or
disease
• Infants, children, and adolescents
regardless of disease
• Communities and public health
• Global health
Primary Care Delivers Better
Health Outcomes
 mortality
 morbidity
 medication use
per capita expenditures
patient satisfaction
greater equity in health care
SOURCE: B. Starfield, et al., “The Effects of Specialist Supply on
Populations’ Health,” Health Affairs (March 2005); W5-97
The Patient-Centered Medical Home as
a Preferred Model of Care
• Change is coming:
– Patients want more from the healthcare
system and from their physician.
– Purchasers of insurance (individuals,
employers, government) are looking for
quality and value.
– Runaway healthcare costs must be
addressed in ways that preserve and enhance
access to high-quality, effective medical care.
– There are ways to do both!
Explore Family Medicine
• Learn more about PCMH. (www.aafp.org/pcmh)
• Advocate for your patients.
• Think about the future of healthcare. Are you
learning the skills today that you will need for the
changing healthcare system?
• Visit Virtual FMIG. (www.fmignet.aafp.org)
• Join your local FMIG.
• Join the AAFP. (www.aafp.org)
• Get involved at the state and national level.