1. The Patient-Centered Medical Home & Health 2.0 AHRQ Annual Conference September 15, 2009 Michael S. Barr, MD, MBA, FACP Vice President, Practice Advocacy & Improvement Division of Governmental Affairs & Public Policy 202-261-4531 mbarr@acponline.org

2. IOM Definition of Patient-Centered Care Healthcare that establishes a partnership among practitioners, patients, and their families (when appropriate) to ensure that decisions respect patients’ wants, needs, and preferences and that patients have the education and support they need to make decisions and participate in their own care. Envisioning the National Healthcare Quality Report, 2001. Institute of Medicine, National Academy Press Accessed at: http://books.nap.edu/openbook.php?record_id=10073&page=41http://books.nap.edu/openbook.php?record_id=10073&page=41

3. Sarasohn-Kahn, J: The Wisdom of Patients: Health Care Meets Online Social Mediia, CHCF April 2009 Health 2.0 Definition “The use of social software and its ability to promote collaboration between patients, their caregivers, medical professionals, and other stakeholders in health.

4. What is Patient-Centered Care? One of IOM’s six domains of quality Picker Institute – 8 dimensions of care “Nothing about me without me” The right care in the right way at the right time Providing the care that the patient needs in the manner the patient desires at the time the patient desires Shaller, D. Patient-Centered Care: What Does It Take? http://www.pickerinstitute.org/documents/PI%20Shaller%20Final%20Report.pdf

5. What is the Patient-Centered Medical Home? …a vision of health care as it should be …a framework for organizing systems of care at both the micro (practice) and macro (society) level …a model to test, improve, and validate …part of the health care reform agenda

7. “PCMH” is a Term… …to describe a pathway to excellent health care …to re-claim a role as advocates for our patients (with our patients & their families) …to encourage team-based care …to create educational opportunities …to attract medical students and residents to primary care

8. The 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 to care Payment to support the PCMH Team-based care: Patient/Family NP/PA RN/LPN Medical Assistant Office Staff Care Coordinator Nutritionist/Educator Pharmacist Behavioral Health Case Manager Social Worker Community resources DM companies Others…

9. Patient-Centered, Physician-Guided Care Adapted from: Defining Primary Care: An Interim Report, Institute of Medicine 1994 Physician Patient Practice Family Team

10. Adapted from: Defining Primary Care: An Interim Report, Institute of Medicine 1994 Physician Patient Practice Family Team Core of Team-Based Care

11. Health 2.0 – Who is Using the Internet? 74% of Americans go online 61% of adults look online for health information For health/medical issues: – 86% of all adults ask a health professional – 68% of all adults ask a friend or family member – 57% of all adults use the internet – 54% use books or other printed reference material Source: Pew Internet & American Life Project http://www.pewinterent.org/reports/2009/8-The-Social-Life-of-Health-Information.aspx

12. Health 2.0 – Impact on Decisions/Actions Of the 60% who use online health information (e- patients): – 60% say the information affected a decision about how to treat an illness or condition – 53% say it led them to ask their physician new questions or to get a second opinion – 49% say it changed the way they think about diet, exercise, or stress management – 60% say they or someone they know has been helped Source: Pew Internet & American Life Project http://www.pewinterent.org/reports/2009/8-The-Social-Life-of-Health-Information.aspx

13. Patient Team Health 2.0 Practice Team The New PCMH Team?

14. Practice Implications Challenges of transformation Initial capital and restructuring costs Ongoing support & maintenance Reporting on quality, cost and satisfaction Implementation of HIT coincident with PCMH Cultural change Information overload Shift/sharing of “power”

16. A Commitment to Excellence Patient-centered communication Shared decision making Timely access to care Transparency & accountability Electronic health records Use of comparative effectiveness research & evidence-based guidelines Safety Measure, improve, measure