2. @Paul_PCPCC Extracting Value Patient Centered Medical Home
Paul Grundy MD, MPH - IBM Director, Healthcare Transformation
@Paul_PCPCC

3. Beyond Flexner --- Driven by Actionable - Personalized Data

4. Course Objectives
participant will understand/be able to discuss the important trend of PCMH in health care
participant will understand/be able explore the rationale and supporting evidence for PCMH
- participant will understand/be able understand the impact on patients, providers and payers
Disclosure:
– I am a full time Employee of IBM I WILL NOT discuss any pharmaceuticals, medical procedures, or devices
I have gratefully had my expenses covered to do some of my talks about PCMH by Abbvie, Merck, and Pfizer.

5. North Carolina Starts the movement
When Look at the Landscape CCNC was who was called CCNC now into year 18 !! – CCNC at the first roundtable pre-PCPCC.
Jan Idaho Embraces Medical Home Model Statewide Programs Seek to Facilitate Innovative Care Transitions

6. In much of the world, no one is in charge.
And the result is the most wasteful and Unsustainable
– BUT -where the delivery system works – a Patient in a trusting relation with a healer who is a comprehensivist with data is in charge”

8. @Paul_PCPCC Away from Episode of Care to Management of Population
WITH DATA
Population
Health
System Integrator
Patient
Experience
Per Capita Cost
Public
@Paul_PCPCC
Community Health
The System Integrator
Creates a partnership across the medical neighborhood
Drives PCMH primary care redesign
Offers a utility for population health and financial management

9. Smarter Healthcare 36.3% Drop in hospital days 32.2% Drop in ER use
12.8% Increase Chronic Medication use
-15.6% Total cost
10.5% Drop Inpatient specialty care costs
18.9% Ancillary costs down
15.0% Outpatient specialty down
Outcomes of Implementing Patient Centered Medical Home Interventions: A Review of the Evidence from Prospective Evaluation Studies in the US - PCPCC Oct 2012

10. 24 July 2014 Michigan Blues’ patient-centered medical home program shows statewide transformation of care YEAR 6
9.9 percent lower rate of adult ER visits
27.5 percent lower rate of adult ambulatory care sensitive inpatient stays
11.8 percent lower rate of adult primary care sensitive ER visits
8.7 percent lower rate of adult high-tech radiology usage
14.9 percent lower rate of pediatric ER visits
21.3 percent lower rate of pediatric primary-care sensitive ER visits
4,022 primary care doctors at 1,422 practices around the state in its sixth year of operation. These practices care for more than 1.2 million BCBSM members.

11. USA 2012
Ogden UT

12. Wienke Boerma
Nivel Institute
Utrecht, Holland.
Amb Wos

14. Watson is ushering in a new era of computing
Tabulating
Systems Era
Programmable
Systems Era
Cognitive
Systems Era
Watson is ushering in a new era of computing
2011
1900
1950
© 2014 International Business Machines Corporation

16. MobileFirst Patient Consumer

17. Practice transformation away from episode of care
Preventive
Medicine
Medication
Refills
Acute Care
Nursing
Test Results
Master Builder
DOCTOR
Chronic Disease
Monitoring
Case
Manager
Behavioral
Health
Medical
Assistants
Source: Southcentral Foundation, Anchorage AK

18. PCMH Parallel Team Flow Design: the glue is real data, not a doctor’s brain
Medication
Refills
Chronic
Disease
Monitoring
Test
Results
Acute
Care
Preventive
Medicine
Point of
Care Testing
Mental
Health
Complaint
Compliance
Barriers
Healthcare
Support
Team
Behavioral
Medical
Assistants
Case
Manager
Clinician
Source: Southcentral Foundation, Anchorage AK

19. Healthcare Will Transform --- Family Medicine for America’s Health
Data Driven
Every person has a plan
Team based
Managing a population down to the person .

20. Today’s Care
PCMH Care
My patients are those who make appointments to see me
Our patients are the population community
Care is determined by a proactive plan to meet patient needs with or without visits
Care is determined by today’s problem and time available today
Care is standardized according to evidence-based guidelines
Care varies by scheduled time and memory or skill of the doctor
We measure our quality and make rapid changes to improve it
I know I deliver high quality care because I’m well trained
A prepared team of professionals coordinates all patients’ care
Patients are responsible for coordinating their own care
We track tests & consultations, and follow-up after ED & hospital
It’s up to the patient to tell us what happened to them
Clinic operations center on meeting the doctor’s needs
A multidisciplinary team works at the top of our licenses to serve patients
Slide from Daniel Duffy MD School of Community Medicine Tulsa Oklahoma

21. Defining the Care Centered on Patient
Superb Access to
Care
Team Care
Patient Engagement in Care
Communication Patient Feedback
Clinical Information Systems, Registry
Mobile easy to use and Available Information
Care Coordination

22. Trajectory to Value Based Purchasing:
Achieving Real Care Coordination and
Outcome Measurement
HIT Infrastructure: EHRs and Connectivity
Primary Care Capacity: Patient Centered Medical Home
Operational Care Coordination: Embedded RN Coordinator and Health Plan Care Coordination $
Value/ Outcome Measurement: Reporting of Quality, Utilization and Patient Satisfaction Measures
Value-Based Purchasing: Reimbursement Tied to Performance on Value (quality, appropriate utilization and patient satisfaction)
Achieve Supportive Base for ACOs and Bundled Payments with Outcome Measurement and Health Plan Involvement
Source: Hudson Valley Initiative

23. Payment reform requires more than one method, you have dials, adjust them!!!
“fee for health”
“fee for value”
“fee for outcome”
“fee for process”
“fee for belonging
“fee for service”
“fee for satisfaction”

24. Businesses are no longer accepting cost-shifting.
40% of commercial in-network payments are value-based up from 11%
Government and private insurers increasingly are paying for value and outcomes, not volume; they are also employing new payment models for hospitals and clinicians.
Half of these payments are “at risk” and half are upside only.

25. Transformation is Here
HHS to spend $840 million on readying practices for value-based pay. -- Part of the 10 Billion
The Transforming Clinical Practice Initiative will invest $840 million over four years to support 150,000 clinicians.
It will provide a combination of incentives, tools and information to encourage doctors to team with peers and others to transition to value-based services.
Momentum building toward value-based payment methods, this initiative hopes to leverage the success of leading practices, health systems and professional orgs to coach others in how to best move to value-based reimbursement. It fits well into the broader federal strategy.
Transforming Clinical Practice
Group practices health systems and Medical Societies
Impact 150,000 clinicians
AND You ARE READY!!!!!!!

26. Benefit Redesign - Patient Engagement Different Strategies for Different Healthcare Spend Segments
Those with severe, acute illness or injuries
% Total Healthcare Spend
Those with chronic illness
Those who are well or think they are well
% of Members

27. Global Information Framework Public Health Prevention
PCMH 2.0 in Action
A Coordinated
Health System
Hospitals
Community Care Team
Nurse Coordinator
Social Workers
Dieticians
Community Health Workers
Care Coordinators
Public Health Prevention
HEALTH WELLNESS
Health IT
Framework
PCMH
Global Information Framework
Specialists
Evaluation
Framework
PCMH
Operations
Public Health Prevention

28. need to move from traditional care provider to health partner
if your do not choose innovation (play a better game) you will be forced into disruption ( game Changed for you). Honest you can see it coming and some places is already there
Millennials are already finding the convenience, economics and technology in powerful virtual engagement compelling so you can chose innovation or disruption.
Virtual access become a required defensive strategy Primary Care team engaged in virtual augmented relationship – or your history loss the relationship.

30. Thank you

31. A comprehensive approach helps reduce costs while improving care
Apply new insights from interactions and outcomes to enable continuous transformation
LEARNING
Identify and influence individuals and populations, and recognize intervention opportunities
INTERVENTION
COORDINATION
Deliver care and monitor progress across clinical and social requirements
COLLABORATION
Assess and engage individuals and stakeholders to drive individualized care plans
Drive evidence-based and standardized care planning
KNOWLEDGE
WELLNESS

32. Asking New Questions From To How many patients can you see?
How many patients’ problems can you solve?
How can we encourage and convince patients to get required prevention?
How can we create systems that significantly increase that patients get required prevention?
How often should a physician see a patient to optimally monitor a condition?
What is the best way to optimally monitor a condition?
*Source: 2014 Kaiser Permanente Jack Cochran 32

33. What new skills are required for the future family physician and what old skills might no longer be necessary?
How can we know if the changes underway in our practices are good for patients?
What are the implications for how we teach and study family medicine?
What new payment models will be required for this model of care to succeed?