1. Ideal Medical Practices

2. RI IMPS Barrington Family Medicine ( Drs Andrea Arena and Lisa Denny) North Kingstown Family Practice ( Dr Lynn Ho) Primary Care of Barrington ( Dr Greg Sadovnikoff) Dr Solmaz Behtash Wickford Family Medicine ( Dr John Machata)

6. Primary care burnout 30% of primary care doctors age 35-49 and 52% age >50 plan to leave their practice within 5 years Half of surveyed primary care physicians report at least one symptom of burnout

7. Fewer primary care physicians 44,250 full-time-equivalent (FTE) physicians will be lost from the workforce More than 50 percent of physicians will cut back on patients seen, work part-time, switch to concierge medicine, retire, or take other steps likely to reduce patient access A Survey of America’s Physicians: Practice Patterns and Perspectives 2012

8. Fractured care 50 % of patients leave doctor’s office without understanding the advice their physicians gave 42% of primary care physicians report not having adequate time to spend with their patients In one study 25% of visits patients were unable to express their concerns at all

9. What is an IMP? A practice model designed to enhance doctor-patient relationships increase face-to-face time between doctors and patients reduce physician workloads instill patients with a sense of responsibility for their health cut wasted dollars from the entire system

10. What is IMP? Ideal Micro Practice (IMP): the smallest functional work unit* capable of delivering superb care in a vital and sustainable environment. IMP : Ideal Medical Practice: not necessarily limited to care provided by solo physician practices.

11. IMP principles Superb care is “good collaborative care.” Good collaborative care results in: improved markers of chronic disease management increase patient satisfaction with the experience of care lower total cost of health care.

12. IMP principles The components of good collaborative care include: Superb access: continuous healing relationships and not just “office visits” Superb efficiency: patient time is not wasted Superb continuity: patient knows their physician/care team and visa-versa. Access to excellent information from which the patient can make good decisions regarding their health The confidence to make good decisions

13. IMP principles Relationship based : doctor/ patient Access: email, phone, pager... Reduce physician workloads: technology facilitates care Instill patients with confidence so that they can take responsibility for their health Low overhead ( typically 30%) Measure whole person and practice

14. IMPs typically have: Open access scheduling 24/7 access by cellphone E-mail access Online scheduling Smaller patient panels e-Prescriptions Home visits Virtual web visits Web portals Performance data via How's Your Health Telephone coaching

15. NOT REQUIRED IMP FEATURES Solo practice Small office size Primary care physicians No staff Homemade exam tables and patient gowns Source of payment (cash, insurance, Medicare, retainer fee, chickens)

18. Ideal Care Defined Through Patient Experience: HOW’S YOUR HEALTH “I can get care when and how I need it” “I have a PCP who knows me as a person” “My PCP takes care of the bulk of my health care needs” “My PCP coordinates any and all care I need”

21. How are we doing (compared to usual care) Twice as many patients who use IMPs report they receive care that is "exactly what they want and need exactly when and how they want and need it" (68% vs 35%). IMPs are more likely to have patients report very high levels of continuity (98% vs 88%), efficiency (95% vs 73%), and access (72% vs 53%). Patient ratings of very good information (83% vs 67%) and clinician awareness of pain or emotional problem are also higher (87% vs 69%).

22. Won’t IMPs Increase Primary Care Physician Shortage? Increase supply: – Make Primary Care Doctors Happier – Eliminating payment disparities in medical financing Increase practice capacity through extramural support – Telephone coaches – Clinical Microsystems or Teamlets

23. Primary care shortage Numbers of Primary Care Providers In the US--2009 Family Physicians--112,000+ Internists--50,000 General Pediatricians--58,000 Nurse Practitioners--100,000 Primary Care Physician Assistants--16,000 Total Number of Primary Care Doctors: 220,000 Total Number of Primary Care Providers: 336,000 Population of US is about 310,000,000 Number of Patients/Primary Care Physician: 1409 Number of Patient/Primary Care Provider: 922

24. IMP MAP

25. Resources/ IMP Impcenter.org : Resources for IMPS Links to efforts to reform health care through the reinvigoration of primary care Funded by Physicians’ Foundation for Health Systems Excellence and The Commonwealth Fund Advocacy and Research

27. References J Ambul Care Manage. 2006 Jul-Sep;29(3):215-21. The emergence of Ideal Micro Practices for patient-centered, collaborative care. Moore LG1, Wasson JH, Johnson DJ, Zettek J. J Ambul Care Manage. 2006 Jul-Sep;29(3):215-21.