Panel Discussion The Medical Home Project High Peaks Resort,Lake Placid Saturday, January 31, 2009

Panel Jeff Stone, MD- Latham Medical Group, a division of Community Care Physicians Diane Cardwell,MPA, ARNP - TransforMed Brian Morrissey - Capital District Physicians Health Plan (CDPHP) Martin Kohn, MD,MS,FACEP,CEP

Introduction - Dr.Jeff Stone TransforMed and the Patient Centered Medical Home - Ms. Diane Cardwell Insurers Perspective - Mr. Brian Morrissey Employers Perspective - Dr.Martin Kohn Physicians Perspective - Dr. Jeff Stone

Diane Cardwell, MPA, ARNP Practice Facilitator January 31, 2009 Patient-Centered Medical Home

Our mission is the transformation of healthcare delivery to achieve optimal patient care, professional satisfaction and success of primary care practices.

How is a PCMH different from what we are already doing? Patient Centered vs. Provider or Practice Centered Forms the foundation for a healthcare partnership with patient and care network Involves proactive care vs. reactive care Practice culture that advocates for and demands what is needed to provided patient-centered, integrated, coordinated care

Creating a Patient Centered Medical Home Requires attention to relationships –Between the practice and the patient –Among members of the practice –Between the practice & the community

What we know about Practice Transformation… Requires a team effort Cannot be achieved merely through new technology Takes time Can take unexpected turns

Critical Success Factors in Transformation Leadership Teamwork Communication

When the leadership system is in place the practices ability to adopt change accelerates significantly. Leadership drives the culture.

Teamwork Transformation is a team effort!

Communication As the numbers of people involved in a communication increases, so does the complexity of the communications & the potential for misunderstanding!

Questions?

Brian Morrissey CDPHP VP, Strategy & Development January 31, 2009

Why are Most Health Plans Interested in the Medical Home? Care delivered by primary care physicians in a patient-centered medical home is consistently associated with better outcomes, reduced mortality, fewer preventable hospital admissions for patients with chronic diseases, lower utilization, improved patient compliance with recommended care, and lower Medicare spending. PCMH Evidence Document: PCPCC Call-to-Action Summit 11/7/07

CDPHPs Interest SAVING PRIMARY CARE!

Mission & Vision Vision: –Create an innovative and sustainable model for the reimbursement of primary care physicians leading to a resurgence in the interest in primary care medicine as a career for medical students. Accomplish this while demonstrating better health outcomes and market-leading satisfaction scores for patients, employers, and physicians. Mission: –The transformation of primary care practice and payment mechanisms to enhance the value of health care delivery and primary care physician satisfaction.

Virtual All Payer Pilot Cant practice two different ways Autonomy Speed Unique commitment of CDPHP

CDPHP Pilot Practice Reform Payment Reform

Pilot Hypothesis Are the aggregate savings associated with better health outcomes and lower utilization sufficient to fund the enhanced compensation to a primary care physician?

Payment Reform Comprehensive payment for comprehensive care Align financial incentives Create an opportunity to significantly increase primary care physician income (35 – 50%)

Payment Reform – Compensation Today CDPHP TodayTypical MH Pilot

The Evils of RBRVS Reimbursement (aka FFS) Incents more care, not better care Limits innovation in care delivery Unintentionally designed to frustrate providers and patients by driving down length of visit No incentive for care coordination No incentive for better outcomes Significant driver for the primary care crisis

Payment Reform – CDPHP Pilot 70% Risk Adjusted Comprehensive Payment * 3% FFS - RBRVS 27% Bonus Payment * Targeted at improving base reimbursement approximately $35,000 to reflect increased costs of implementing and operating a medical home.

Risks Both practice and payment reform are really, really hard ROI may not be demonstrated, or if it exists, may be transient May end up deploying a model that cannot handle the pressures of the real world

Bigger risk is the disappearance of primary care

Questions

IBM in Healthcare and Life Sciences IBM Healthcare Martin S. Kohn, MD, MS, FACEP, CEP November 11, 2008

Our Vision Healthy People for a Productive World Our Client Commitment Innovations that improve quality and value, leading to consumer-centric and personalized healthcare

How do you start to fix the foundational issue around why our healthcare system is so expensive and yet so broken?? Average spending on health per capita ($US PPP) 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

Primary care - focus on comprehensive care Many studies show that when our primary care providers focus on the comprehensive needs of our employees they end up in the hospital less, the emergency room less and their overall care costs less. Many studies also show that the practice of episodic care by a partialist (specialist) without someone in charge of overall care is dangerous, wasteful and frankly unacceptable. Starfield B,Shi L. Policy relevant determinants of health: an international perspective. Health Policy 60 (2002) 201–218.. Grumbach K, Bodenheimer T. A primary care home for Americans: putting the house in order. JAMA 2002;288: Future of Family Medicine Project Leadership Committee. The future of family medicine: A collaborative project of the family medicine community. Ann Fam Med. 2004;2(Suppl 1):S3– The Advanced Medical Home. The American College of Physicians, Grumbach K, Selby JV, Damberg C, et al: Resolving the gatekeeper conundrum. JAMA. 1999;282:

IBM envisions a new Healthcare System … patients Wellness Healthcare system that is built around patients and focused on Wellness –Patient-Centered Medical Home model – providing better outcomes for patients –Wellness Focus – where physician are paid for effective wellness management transformed healthcare system A transformed healthcare system where all stakeholders participate in the transformation …….. –Consumers will assume much greater financial oversight and responsibility for their healthcare, –Payers will take a more holistic view of value –Societies will understand that healthcare funds are not limitless and will demand that payment for and quality of healthcare services be aligned with the value

Hospital Systems / Practice Mgt. Systems IBMs Strategy is to Transform Healthcare -- with effective information exchange Health Record (EHR) Payer Clinical Information Exchange Employer Health Card Patient Employee Member Subscriber Services Capital Authenticated Access PHR Eligibility, Plan Data Plan Pay Advice Consumer Payment Consumer Advice Plan Settlement Sources of Payment Membership Stake Adjudication Settlement Medicare Medicaid FSA HSA MasterCard Visa Amer Exp Discover Fidelity Tricare Determine Liability Updated Accumulators Request for Payment Remittance Advice Patient Employee Member Subscriber Personal Health Record (PHR) Manage Care Access PHR Use Tools PHR Smart Medical Devices … with ultimate focus on wellness

IBM has transformed itself and has achieved great results projected includes healthy living rebate Source for benchmarks: Average of survey results from Kaiser Family Foundation, Hewitt Associates, and Towers Perrin projected 2007 data in currently being finalized

We are the ones weve been waiting for Obama Feb. 5, 2008

The Role of IBM with our Clients and Partners in Patient-Centric Healthcare Deliver innovative solutions –Leadership in technology and clinical integration –Improved access to information and optimized workflows –Influential application provider relationships Drive adoption –Cultivate the global ecosystem –Form relationships with a critical mass of collaborators –Encourage the development of value nets –Lead in open standards Set an example as a best practices employer –Effectively manage IBMs Global Health and Wellness programs –Lead in motivating the use of EHR and PHR –Serve as a Health System advisor

In assuming more responsibility for their care, consumers must make wiser health and financial decisions as patients and purchasers Improve access to information Health Coach Prediction Healthy lifestyles Behavioral Change Make better health-related choices Wealth Coach Financial planning Financing options Insurance options Improve financial planning for healthcare Value Coach Health plan benefits Provider selection Comparative value Receive personalized high-value care Analysis Continued shift from employer-based to government-based and individual coverage Increase in consumer responsibility and accountability New healthcare requirements, delivery models, capabilities, and reimbursement models

IBMS Patient Centered Collaborative Care Process Care Team Collaboration Select Care Providers Provide On-going Care Gather Individual Health Information Measure & Reward Measure & Reward Assess Health Pay for Products & Services Enroll Patient in Programs Enroll Patient in Programs Design Care Plan Improve Process Aggregation of health information Clinical / Biometrics / Claims Comprehensive View Focus on Wellness & Prevention Enroll in programs Employer Government Self-insured Risk stratification Determine focus areas Prioritization Evaluate provider options Consider alter- natives Fit with needs Evaluate care options Select treatments, products, & services Based on clinical input, quality metrics, personal needs, & health plan options Execute care plan Acute, chronic, or wellness plan Collect metrics to establish efficacy Payments Health plans Medical home programs Retail Monitor performance Clinical procedures & processes Administrative business process Program efficacy Improve outcomes Quality of life Patient Satisfaction ROI

Evidence Generation & Health Analytics Physicians & Specialists Health Information Warehouse Patients Dx, Rx Pharma, Labs, Diagnostics, Claims, Other Health Info Public Health Portal Access Layer Disease Dashboards & Work Flow Data Acquisition & Integration User Portals & Portlets Health Information Operational Store Electronic Medical Records IBM Pc3 Solution (Conceptual View) Public Data Sources Patient Portal & Monitoring Quality Measures & Patient Safety ResearchersCase Worker Clinical Admin PayerState Patient Identity Mgmt Data Integration Layer Clinical Decision Support & Health Analytics Personalized Care Diagnosis & Treatment User Interaction Process Mgmt Information Mgmt Enterprise Service Bus

IBM Pc3 will require key questions to be answered Consumers Who has the best outcomes? What preventive tests should I have? When can I see my doctor? Do I have immunizations due? Employers What are my most cost effective care options? How can I measure the wellness of my employees? Who provides the highest quality care? Physicians and Care Team What are the outcomes of my patient populations by disease profile? When are the preventive tests and immunizations due? How can I better manage my referrals? How compliant is my practice to key core measures and other metrics? What are my costs of services? Health Plans What are my member outcomes? Have I reduced the number of unnecessary ER visits? How do I manage and report the progression and impact of chronic diseases such as diabetes or stroke within a system, region or market ? How do I predict high risk populations and begin early interventions?

The Physicians Perspective Jeff Stone,MD Family Physician

Important Philosophy of the PCMH (AAFP 2008) Continuing, comprehensive and personal care in the context of family and community. Taking into account the physical, psychological and spiritual nature of wellness and disease. Continuing, comprehensive and personal care in the context of family and community. Taking into account the physical, psychological and spiritual nature of wellness and disease. –Sound familiar? – like maybe the core values of primary care

48 Page 48 How do you start to fix the foundational issue around why our healthcare system is so expensive and yet so broken?? Average spending on health per capita ($US PPP) 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

49 Page 49 Countries age-standardized death rates, list of conditions considered amenable to health care Source: E. Nolte and C. M. McKee, Measuring the Health of Nations: Updating an Earlier Analysis, Health Affairs, January/February 2008, 27(1):58–71 USA worse/19 37 th by WHO

50 Page 50 We do heart surgery more often than anyone, but we need to, because patients are not given the kind of coordinated primary care that would prevent chronic heart disease from becoming acute. George Halversons (CEO Kaiser) Healthcare Reform Now

The Case for The Medical Home

Important Philosophy of the PCMH (AAFP 2008) Continuing, comprehensive and personal care in the context of family and community. Taking into account the physical, psychological and spiritual nature of wellness and disease. Continuing, comprehensive and personal care in the context of family and community. Taking into account the physical, psychological and spiritual nature of wellness and disease. –Sound familiar? – like maybe the core values of primary care

Questions?