1. National Medical Home Summit, 2009 Jaan Sidorov, MD, MHSA – Sidorov Health Solutions Doug Berkson, MPH – Health Dialog

2. Agenda Traditional Disease Management & the PCMH and Potential Areas of Collaboration Synergy - Sidorov Lessons from One “Disease Management Organization”: Utilizing data aggregation, health informatics/analytics, & health coaching in support of Medical Homes: Data aggregation and analytics Practice-based and/or Physician-directed care management Measurement PCMH in the context of Unwarranted Variation Final views & thoughts

3. Agenda Traditional Disease Management & the PCMH and Potential Areas of Collaboration Synergy Lessons from One “Disease Management Organization”: Utilizing data aggregation, health informatics/analytics, & health coaching in support of Medical Homes: Data aggregation and analytics Practice-based and/or Physician-directed care management Measurement PCMH in the context of Unwarranted Variation Final views & thoughts

4. From Mattke et al: Evidence for the effect of disease management. AJMC 2007;13:670 Disease Management?

5. PCMH Shortcomings in day-to-day clinical practice: 1.Lack of an operational definition, 2.Not a cure the ‘tyranny of the urgent,’ 3.A struggle for small practices, 4.Not a cure the PCP shortage, 5.Unclear if this is for all patients or patients with chronic illness, From Berenson et al: A house is not a home: Keeping patients at the center of practice redesign Health Affairs 2008;27: 1219, and Sidorov: The patient-centered medical home for chronic illness: Is it ready for prime time? Health Affairs 2008;27: 1231

6. PCMH Shortcomings in day-to-day clinical practice: 6.Many local management challenges, 7.Unclear role of non-PCP specialists 8.Should patients be locked-in to their primary care site? 9.All things to all people with “silver bullet” status. 10. No track record of state-of-the-art telephony and monitoring as one ingredient in the suite of population-based services

7. PCMH Shortcomings in day-to-day clinical practice: 11.Suspect MCO network scalability 12.If you build it, will physicians come? 13.If you build it, will medical students come? 14.Unmentioned remotely positioned PCMH resources 15.Individual PCMH elements “save money,” but scanty evidence lacking of claims reductions or impact on trend. 16.No information on impact on variation

8. From the American Academy of Family Physicians DMOs need to move from helping patients becoming engaged to: helping the struggling clinics become expert training office staff in registry and care coordination functions, providing patient self management support, helping leverage community services providing 24/7 telephonic support. http http :// diseasemanagementcareblog.blogspot.com/2008/09/disease-management-patient-centered.html

9. From DMAA: The Population Health Alliance Much overlap between NCQA DM Accreditation and PCC-PCMH Recognition DMOs have considerable health information technology resources: Predictive modeling Secure portals with patient info, care plans and decision support Integration with existing EHRs & PHRs http://www.dmaa.org/pdf/DMAA_PHI-PCMH_102108.pdf

10. DM-PCMH “Coopetition?” Disease Management Population focused Disease managers Remote patient activation Change patients & physicians P4Participation Insurance risk/savings MarketPCMH Office practice focused Multidisciplinary teams Local patient activation Change physicians & patients Use P4P to underwrite? Revenue Policy SHS©