Presentation on theme: "The Patient Centered Medical Home in the Information Age"— Presentation transcript:
1 The Patient Centered Medical Home in the Information Age Ted Epperly, M.D.Program Director and C.E.O.Family Medicine Residency of IdahoClinical Professor of Family and Community MedicineUniversity of Washington School of MedicinePresident-ElectAmerican Academy of Family Physicians
2 Five Ages of Civilization WisdomInformation/Knowledge WorkerIndustrialAgriculturalHunter/Gatherer
3 Failure to Embrace Family Medicine Despite its 39-year history, neither the general public nor healthcare professionals understand all that Family Medicine represents.
5 “Strategic planning does not deal with future decisions “Strategic planning does not deal with future decisions. It deals with the futurity of present decisions. Decisions exist only in the present. The question that faces the strategic decision-maker is not what his organization should do tomorrow. It is: What do we have to do today to be ready for an uncertain tomorrow?”-Peter Drucker
6 “Don’t skate to where the puck is, but where the puck will be.” - Wayne Gretzky
7 The Future of Family Medicine Charge “Develop a strategy to transform and renew the specialty of family practice to meet the needs of people and society in a changing environment.”
8 Simple Rules for the 21st Century Health Care System Current ApproachNew RulesCare is based primarily on visitsCare is based on continuous healing relationshipsProfessional autonomy drives variabilityCare is customized according to patient needs and valuesProfessionals control careThe patient is the source of controlInformation is a recordKnowledge is shared and information flows freelyDecision making is based on training and experienceDecision making is evidence-basedSource: Crossing the Quality Chasm: A New Health System for the 21st Century, Committee on Quality of Health Care in America, Institute of Medicine Washington, DC, USA: National Academies Press; 2001
9 Simple Rules for the 21st Century Health Care System Current ApproachNew RulesDo no harm is an individual responsibilitySafety is a system propertySecrecy is necessaryTransparency is necessaryThe system reacts to needsNeeds are anticipatedReduction in cost soughtWaste is continuously decreasedPreference is given to professional roles rather than the systemCooperation among clinicians is a prioritySource: Crossing the Quality Chasm: A New Health System for the 21st Century, Committee on Quality of Health Care in America, Institute of Medicine Washington, DC, USA: National Academies Press; 2001
10 Future of Family Medicine Ten Recommendations New Model of Family MedicineElectronic Health RecordsFamily Medicine EducationLife Long LearningEnhancing the Science of Family MedicineQuality of CareRole of Family Medicine in Academic Health CentersPromoting a Sufficient Family Medicine WorkforceCommunicationsLeadership and AdvocacySource:The Future of Family Medicine - Annals of Family Medicine
11 New Model of Family Medicine Personal Medical HomePatient-Centered CareTeam ApproachElimination of Barriers to AccessAdvanced Information SystemsRedesigned OfficesSource:The Future of Family Medicine - Annals of Family Medicine
12 New Model of Family Medicine (cont’d) Whole-Person OrientationCare Provided within a Community ContextEmphasis on Quality and SafetyEnhanced Practice FinanceCommitment to Provide Family Medicine’s Basket of ServicesSource:The Future of Family Medicine - Annals of Family Medicine
13 Medicine Work Force 300,000,000 Americans 900,000 Physicians 333:1 American/Physician
14 Number of Physicians Per Capita Total physiciansFP/GPAMA 2007Total Number of Physicians – 902,053Family Medicine Physicians – 80,809Source: AMA Physicians Characteristics and Distribution 1980, 1990, 2000,Overpeck MD. Physicians in family practice Public Health Rep 1970; 85(6):
15 Which System is More Stable? PrimaryCareSpecialistsOR
16 Why? Salary Lifestyle Increasing Medical School Debt Perceived PrestigeRising OverheadUnfunded Mandates
17 Median Compensation for Selected Medical Specialties Data are from the Medical Group Management Association Physician Compensation and Production Survey, 1998 and 2005
19 Source: Lebow R. Health Care Meltdown: JRI Press: 2002 America’s Rankings#1 -Health Care Dollars Spent Per CapitaHealth Care TechnologyResearch Dollars Spent Per Capita#20 -Health Care Outcomes (e.g. life expectancy, infant mortality, and immunizations)#37 -Health Care System#54 -Fairness (tied with Fiji)Source: Lebow R. Health Care Meltdown: JRI Press: 2002
20 Starfield B. Is U. S. Health Really the Best in the World Starfield B. Is U.S. Health Really the Best in the World? JAMA 2000; 284(4):
21 Starfield B. Is U. S. Health Really the Best in the World Starfield B. Is U.S. Health Really the Best in the World? JAMA 2000; 284(4):
27 Rationale for the Benefits of Primary Care for Health Greater Access to Needed ServicesBetter Quality of CareA Greater Focus on PreventionEarly Management of Health ProblemsCumulative Effect of Primary Care to more Appropriate CareReducing Unnecessary and Potentially Harmful Specialist CareSource: Starfield B., Leiyu S., Mackinko J., Contribution of Primary Care to Health Systems and Health, (Milbank Quarterly, Vol. 83., No. 3, 2005) )
28 Rationale of a Primary Health Care Based System Decreased Morbidity and MortalityMore Equitable Distribution of Health in PopulationsLower Cost of CareBetter Self-Reported HealthPrimary Care Physicians achieve Better Outcomes than do Specialists at much Lower CostsIncreasing the Number of Specialists is Associated with Lower Quality, Increased Cost, Increased Morbidity, and Increased MortalitySource: Starfield B., Leiyu S., Mackinko J., Contribution of Primary Care to Health Systems and Health, (Milbank Quarterly, Vol. 83., No. 3, 2005) )
29 “Too many specialists are as dangerous to the quality and quantity of medical care in a community as too few.”- Stanley R. Truman, M.D.President Elect AAGPSeptember 13, 1949
30 Not Just a Change In Name… but a Change In Attitude! AGGRESSIVE OPTIMISM!
34 Health Care for Everyone Medical HomeNo Financial Barriers forPrimary CarePrenatal CareWell Child CareImmunizationsEvidence Based Preventive ServicesHospice Care
35 Health Care for Everyone (cont’d) The Individual will Share Financial Responsibility for:MedicationsHospitalizationsDurable Medical EquipmentED visitsConsultations and ReferralsDx Tests and Procedures not done in Medical HomeLong-Term Care
36 Health Care for Everyone (cont’d) How is this paid for?Enhanced Fee for ServiceP4RP4PCMFCare Management Fee$15 PMPMLewin Group$8 Billion Cost to CMS but Saves $15 Billion/Year$48 Billion Cost to Rest of U.S. but Save $83 Billion/YearSaves $15.63 /Person Per Month
37 Health Care for Everyone (cont’d) The Type of Payment System Does Not MatterWhat Does Matter:Primary Care Based SystemMedical HomePrimary Care Physicians – Integration/Coordination/RelationshipsHigher Quality, Better Outcomes, More Preventive Services, Improved Patient Satisfaction, Significantly Lower Costs
38 Joint Principles of the Medical Home (AAFP, ACP, AAP, AOA) Personal PhysicianPhysician Directed Medical PracticeWhole Person OrientationCare is Coordinated and IntegratedQuality and Safety are HallmarksAccess is EnhancedPayment Reform
40 Patient Centered Primary Care Collaborative (PCPCC) Employers - 50 Million PlusConsumer Groups - 47 Million PlusPhysician Groups - 330,000 PlusInsurers – All of the Big Six
41 AARP Aetna. American Academy of Family Physicians AARP Aetna* American Academy of Family Physicians* American Academy of Pediatrics* American Board of Medical Specialties American College of Osteopathic Family Physicians American Board of Medical Specialties American College of Cardiology American College of Osteopathic Internists American College of Physicians* American Geriatrics Society American Health Quality Association American Heart Association American Osteopathic Association* Aurum Dx Automotive Industry Action Group BlueCross BlueShield Association* Bridges To Excellence The Capital District Physicians’ Health Plan, Inc. Carena, Inc. Caterpillar The Center for Excellence in Primary Care The Center for Health Value Innovation Colorado Center for Chronic Care Innovations CIGNA* CVS Caremark* § CVS/pharmacy § Caremark Pharmacy Services § MinuteClinic Delmarva Foundation The Department for Family and Community Medicine, University of California, San Francisco Delphi Corporation Deseret Mutual DMAA: The Care Continuum Alliance eHealth Initiative The ERISA Industry Committee* Exelon Corp FedEx Corporation Foundation for Informed Medical Decision Making General Mills, Inc. General MotorsGeisinger Health Systems GlaxoSmithKline Health Dialog HR Policy Association Humana, Inc.* IBM* Incenter Strategies McKesson Corporation MDdatacore Medco* Medical Network One Merck* MVP Health Care National Association of Community Health Centers National Business Group on Health National Business Coalition on Health National Coalition on Health Care National Committee for Quality Assurance National Consumers League National Partnership for Women & Families National Retail Federation New England Quality Care Alliance New York City Department of Health and Mental Hygiene Novo Nordisk The Pacific Business Group on Health Partners In Care Pfizer* Practice Transformation Institute Pudget Sound Health Alliance The Roger C. Lipitz Center for Integrated Health Care at the Johns Hopkins Bloomberg School of Public Health Service Employees International Union Society of General Internal Medicine Society of Teachers of Family Medicine The Stoeckle Center at Massachusetts General Hospital UnitedHealthcare* United States Steel University of Pittsburgh Medical Center Walgreens Health Initiatives* WellPoint, Inc.* Wyeth XeroxUpdated 12/18/07
43 Must Pass Elements at 50% Performance Level PPC-PCMH ScoringLevel of QualifyingPointsMust Pass Elements at 50% Performance LevelLevel 310 of 10Level 250 – 74Level 125 – 495 of 10Not Recognized0 – 24< 5Levels: If there is a difference in Level achieved between the number of points and “Must Pass”, the practice will be awarded the lesser level; for example, if a practice has 65 points but passes only 7 “Must Pass” Elements, the practice will achieve at Level 1.Practices with a numeric score of 0 to 24 points or less than 5 “Must Pass” Elements do not Qualify.
44 NCQA Medical Home – 5 Musts Has written standards for patient access and patient communication;Uses data to show it meets its standards for patient access and communications;Uses paper or electronic charting tools to organize clinical information;Uses data to identify important diagnoses and conditions in practice;Implements evidence-based guidelines for al least three conditions;Actively supports patient self-management;Tracks tests and identified abnormal results systematically;Tracks referrals using a paper-based or electronic system;Measures clinical or service performance by physician or across the practice;Reports performance by physician or across the practice.
45 The Health Care Paradigm BuyersPayorsProvidersBusinessInsuranceCompaniesPhysicians
46 Care Management Fee for PC-MH RVC Proposal to CMS Level 1 - $30Level 2 - $40Level 3 - $50
47 What Next? Advocacy Education Communication Payment Reform Politics / PACTipping Point?
49 “Never doubt that a small group of thoughtful, committed citizens can change the world. Indeed, it is the only thing that ever has.”- Margaret Mead
50 “The only limit to our realization of tomorrow will be our doubts of today, so let us move forward with strong and active faith.”- Franklin D. Roosevelt
51 Summary Medical Home in the Information Age Strategy to Transform and RenewFuture of Family Medicine – New ModelBasket of Services – Integrate and CoordinatePrimary Care Foundational to Health Care SystemMedical Home and DesignationPayment Reform – Blended RateWorkforce ReformPatient Centered Primary Care Collaborative (PCPCC)Health Care for Everyone
52 Patient Centered Medical Home in the Informational Age Questions?