1.  2014 TransforMED Where Are We Now And What Does The Future Hold For Primary Care? Bruce Bagley, MD CEO, TransforMED

2.  2014 TransforMED 2

3. Useful Organizing Construct Current Capacity and Capability Primary Care in 2020 3

4.  2014 TransforMED American Academy of Pediatrics Medical Home (MHCSHCN) 4 AAFP National Demonstration Project (NDP) >TransforMED NCQA PCMH Recognition Program 1970’s 1990’s 2007 2008 Patient-Centered Primary Care Collaborative 2005 CMS CPCi Health Plans, ACOs & Value Based Purchasing 2012 Future of Family Medicine Report 2004 Wagner Chronic Care Model 2014 ACA in place Cost Moderation Mkt. Consolidation PCMH Central to Value Creation Joint Principles IHI ID-COP

5.  2014 TransforMED Continuing, comprehensive and personal care in the context of family and community while taking into account the physical, psychological and spiritual nature of health and disease. 5 “The Triple Aim plus One”

6.  2014 TransforMED  Individual patient care  Population health  Stewardship for health care resources 6 The Triple Aim is About “Right-sizing Health Care” 30%

7.  2014 TransforMED  US uses 30% more laundry detergent than needed for clean clothes  P & G introduces Tide- Pods premeasured soap  Total market size reduced by 30% (“Right-sized”)  P & G able to charge a premium for soap  Market then grows with real increased need 7

8.  2014 TransforMED  Eliminate wasteful or unnecessary tests, treatments or procedures  Discuss “quality of life” and ability to function rather than just survival rates  Rational and compassionate approach to end-of-life care 8

9.  2014 TransforMED  High minute-to-minute responsibility for physicians  Payment necessitates high volume  Hero model still in play  Team underutilized  Technology more of a burden than help 9 “How is that working for you?” -Dr. Phil

10.  2014 TransforMED  Primary care community engaged  Studies show savings but results related to specific strategies (team care, risk stratified care management and care coordination, registries)  Payers increasingly recognizing value of PCMH and providing alternative payment mechanisms  ACOs and integrated systems recognize that they must have a robust primary care infrastructure to succeed  Demand for primary care ups compensation 10

11.  2014 TransforMED  Reshape the health insurance marketplace  Lay the groundwork for value based purchasing  Accountable Care Organizations  Pay differential for quality  Moved the conversation from volume to value  Provide health insurance coverage to a large number of previously uninsured people  More emphasis on wellness and prevention 11

12.  2014 TransforMED  PCMH has been very useful  Design construct  Advocacy  Payment reform  NCQA alone is not enough  Must move on to specific capabilities  The Triple Aim will be the outcome measure 12

13.  2014 TransforMED  Physician leaders  Information technology enabled  Clinical integration  Prepaid global payment system 13 -Robert Pearl, MD –CEO, KPMG “80% of the strategies for managing population health and controlling total healthcare costs are related to Primary Care activities.”

14.  2014 TransforMED 1)Patient/Family/Caregiver Engagement 2)Risk Stratified Care Management 3)Team-based Care 4)Interdependence and Connectedness 5)IT Enabled Systematic Care 6)Culture of Improvement 14

15.  2014 TransforMED  Active patient engagement in managing chronic conditions  Include family and other caregivers  Patient self-management support  Between visit calls and support  Mobile device platform will be required!  Build patient loyalty  Home monitoring 15 www.patientfamilyengagement.org

16.  2014 TransforMED  Determine high risk/high cost patients  Need help managing chronic condition  Need help navigating fragmented system  Develop strategy to get them the extra attention and help that they need when they need it  Care managers, care coordinators for the sickest  Appropriate end of life care 16 www.aafp.org/rscm

17.  2014 TransforMED 17 A systematic, reliable and organized way to get patients what they need… when they need it.

18.  2014 TransforMED 18 Patient (family) Patient (family) Care Management Care Management Care Team Registry Function (EMR) Registry Function (EMR) Home Monitoring Patient Self- Management Support Care Coordination Clinical and Systems Oversight Family and Caregiver Support It Takes A Team! Risk Stratified Care Management and Care Coordination

19.  2014 TransforMED  Strategic distribution of the work  Everyone on the team has a role in the care  Change in patient expectation about care  Technology support for team  Protocols, standing orders and out reach 19

20.  2014 TransforMED  Clinical integration  Free flow of clinical information between points of care  Service agreements with specialists  Hospital link for admission and discharge information  Health plan as a data partner 20

21.  2014 TransforMED  Use EMR to full capabilities  Registries for chronic conditions, high risk patients and preventive care  Online services, patient portals and education  Health, wellness and life-style apps  Full digital engagement with mobile platform 21

22.  2014 TransforMED  Organizational development  Quality improvement science  “Measure-improve-measure mindset”  All feel enabled to suggest improvements in care  Data driven decision making 22

23.  2014 TransforMED  Excel at patient engagement  Earn patient loyalty  Be committed to full digital engagement  Embrace the team approach to care  Have a strategic distribution of the work  Eliminate waste (“non-value added” for patients)  Perfect diagnostic and therapeutic efficiency  Operate in a supportive medical neighborhood 23

24.  2014 TransforMED 24 Providers Payers Health Systems ACO Learning and Diffusion HCIA Medical Neighborhood Comprehensive Primary Care (CPC)

25.  2014 TransforMED  Comprehensive plan of communication, advocacy and action by the “Family of Family Medicine”  Evaluation and update on the Future of Family Medicine Project in 2004  Funded by the participating organizations with $20 million over the next five years  Full communications plan and strategic action plan to be unveiled in October at the AAFP Annual Assembly in Washington, DC 25

26.  2014 TransforMED 1)Show the value and benefits of primary care 2)Ensure every person will have a personal relationship with a trusted family physician or other primary care professional, in the context of a medical home 3)Increase the value of primary care 4)Reduce health care disparities 5)Lead the continued evolution of the Patient-Centered Medical Home 6)Ensure a well-trained primary care workforce 7)Improve payment for primary care by moving away from fee for service and toward comprehensive primary care payment 26

27.  2014 TransforMED  Enlightened physician leadership  Build strong affiliations but be selective  “Feeder team” and trial period  Solid foundation of capable primary care  Redefined “access” and expanded care team  Systematic population health management  Patient engagement and self-management support  Clinical integration  Information technology enabled 27

28.  2014 TransforMED 1. Take stock and identify gaps 2. Solidify leadership and decision making 3. Create a clear vision for your organization 4. Learn what others are doing 5. Prioritize and pace the change 6. Get help if needed… 28

29.  2014 TransforMED  Supportive multi-payer environment  State government as convener and catalyst  Statutory allotment of health care spend to primary care  Manageable geography and travel times 29

30.  2014 TransforMED 30 “If We Build It With Them… They Will Already Be There”  -Christine Bechtel  National Partnership for Women and Families “If We Build It…They Will Come” –Field of Dreams

31.  2014 TransforMED  For more information :  www.delta-exchange.net www.delta-exchange.net  www.transformed.com www.transformed.com  bbagley@transformed.com bbagley@transformed.com  @TransforMEDCEO 31