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Models of Primary Care Primary Care – FAMED 530

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1 Models of Primary Care Primary Care – FAMED 530
William R. Phillips, MD, MPH Primary Care – FAMED 530 Department of Family Medicine University of Washington ©2014 WR Phillips

2 Learning objectives Outline alternative models of primary care:
Chronic Care Model Patient-Centered Medical Home Describe the challenges of practice transformation ©2014 WR Phillips

3 The Triple Aim Improve the patient experience of care
Improve the health of populations Reduce the cost of health care. ©2014 WR Phillips

4 Planned Care Model ©2014 WR Phillips

5 Patient Centered Medical Home
©2014 WR Phillips

6 Joint Principles of the PCMH
Personal physician Physician directed medical practice Whole person orientation Care is coordinated and/or integrated Quality and safety Enhanced access Payment Reform AAFP, AAP, ACP, AOA ©2014 WR Phillips

7 Medical Home features Patient-centered Comprehensive Coordinated
Accessible Committed to quality and safety ©2014 WR Phillips

8 Medical Home features Patient-centered: supports patients in learning to manage and organize their own care at the level they choose, and ensures that patients and families are fully informed partners in developing care plans. Comprehensive: a team of care providers is wholly accountable for a patient’s physical and mental health care needs, including prevention and wellness, acute care, and chronic care. Coordinated: ensures that care is organized across all elements of the broader health care system, including specialty care, hospitals, home health care, and community services and supports. Accessible: delivers accessible services with shorter waiting times, enhanced in-person hours, 24/7 electronic or telephone access, and alternative methods of communication through health IT innovations. Committed to quality and safety: demonstrates commitment to quality improvement through the use of health IT and other tools to guide patients and families to make informed decisions about their health. ©2014 WR Phillips

9 PCMH Patient-centered Comprehensive Coordinated Accessible.
Committed to quality and safety What is new? Why does it sell? ©2014 WR Phillips

10 High Functioning Healthcare Team
Shared goals Clear roles of each team member Shared knowledge and skills Effective timely communication Mutual respect Can-do optimistic attitude of team members ©2014 WR Phillips

11 Transformed Practice Everyone works for the doctor.
Traditional Everyone works for the doctor. The “magic” starts when the doctor enters the room with the patient. Transformed Everyone works for the patient. The “magic” starts when the patient enters the office, or even before with pre- planned visits. ©2014 WR Phillips

12 Practice Transformation
Team function Resources Facilitation Adaptive reserve ©2014 WR Phillips

13 Direct Practice Unlimited access for one low, monthly payment
Unhurried appointments with doctors who focus completely on your health and wellbeing Health care support in person, by phone, or No co-payments, co-insurance, or deductibles No long-term contracts when joining No restrictions based on age or pre-existing conditions—everyone is welcome ©2014 WR Phillips

14 Polyclinic Model Multiple limited specialists Internal Medicine
Pediatrics Obstetrics-Gynecology Access to multiple specialists ©2014 WR Phillips

15 Hub and Spoke Model Inter-professional team
Multiple non-physician clinicians Diagnose and manage common simple problems Triage and refer difficult cases Central physician Manages challenging cases Supervises medical management team ©2014 WR Phillips

16 Med-Peds Model Combined residency training Classical IM 3 years
Classical Peds 3 years Combined Med-Peds 4 years ©2014 WR Phillips

17 PCMH payment reform Recognizes the added value provided to patients.
Reflect the value of care management work that falls outside of the face-to-face visit, by physician and non-physician staff. Pay for services associated with coordination of care within practice and among consultants, ancillary providers, and community resources. Support adoption and use of HIT for quality improvement. Support enhanced communication, such as secure and telephone consultation. ©2014 WR Phillips

18 PCMH payment reform Recognize value of work assoc. with remote clinical monitoring. Allow for separate fee-for-service payments. Recognize case mix in the patient population within the practice. Allow sharing of savings from reduced hospitalizations assoc care management. Allow added payments for achieving measurable and continuous quality improvements. ©2014 WR Phillips

19 Thank You Thanks to the support of Theodore J. Phillips Endowed Professorship in Family Medicine. Department of Family Medicine University of Washington, Seattle, WA ©2014 WR Phillips

20 Contact Information William R. Phillips, MD, MPH Theodore J. Phillips Endowed Professor in Family Medicine Box , Room E304 University of Washington Seattle, WA Tel: (206) ©2014 WR Phillips

21 Patient-Centered Care
1. Explore patient’s disease and illness experience: Feelings about being ill Ideas about what is wrong Impact of the problem on daily functioning Expectations of what should be done 2. Understand the whole person. 3. Reach common ground. 4. Incorporate prevention and health promotion. 5. Enhance the patient-clinician relationship. 6. Be realistic. ©2014 WR Phillips

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