To employers the cost of healthcare is now a business issue and this talk is about what one large buyer IBM did to drive transformation via broad coalition with other large employers to form the Patient Centered Medical Home movement and the covenant between buyer and provider away from the garbage we now buy episodic uncoordinated disintegrated care. In the change of convenient conversation we have worked with the Primary care providers to give us coordinated, integrated, accessible and compressive care with a set of principles know as the Patient centered medical home. A Patient Centered Medical Home (PCMH) happens when primary care healers keeping that core healing relationship with their patients step up to become specialists in Family and Community Medicine. The move is to the discipline of leading a team that delivers population health management, patent centered prevention, care that is coordination, comprehensive accessible 24/7 and integrated across a deliver system. PCMH happens when the specialists in Family and Community Medicine wake up every morning and ask the question how will my team improve the health of my community today? All over the world three huge factors are in play that is driving the concept of Patient Centered Medical Home. They are: 1) Cost and demography 2) Information technology and data (information that is actionable will equal a demand for accountability by the payer or buyer of the care) 3) Consumer demand to engage healthcare differently (at least as well as they can their bank- on line) have a question about lab results why not e-mail? But at its core it is a move toward integration of a healing relationship in primary care and population management all at the point of care with the tools to do just that.

1. West Virginia wants PCMH Level Care Paul Grundy MD, MPH IBM International Director Healthcare Transformation Paul Grundy, MD, MPH, FACOEM, FACPM IBM Director Healthcare Transformation President Patient Centered Primary Care Collaborative Trip to Denmark July 10 2009

2. Who was the Shooter’s Doctor? Away from Episodes of Care - FFS Population management !! Accountability !!

3. If we truly want to understand costs and where they can be reduced without compromising outcomes, we need to aggregate costs around the patient. (need a place to do that – that is PCMH) The way care is currently organized leads to redundant administrative costs, unnecessary and expensive delays in diagnosis and treatment, and unproductive time for physicians. A system integrator a place where data is aggregated, understood and held accountable at the level of the individual patient -- THAT IS PCMH. In fact, cost reduction will often be associated with better outcomes. The Big Idea: How to Solve the Cost Crisis in Health Care by Robert S. Kaplan and Michael E. Porter Sept 2011 Harvard review

5. The Cause? Mostly due to unregulated fee-for-service payments and an over reliance on rescue/specialty care . This is stark evidence that the U.S. health care Industry has been failing us for years “Commonly cited causes for the nation's poor performance are not to blame - it is the failure of the deliver system !!” - Unaccountable Care Organizations * Peter A. Muennig and Sherry A. Glied Health Affairs Oct. 7, 2010 Dubuque , Iowa WV 2011

6. Deaths per 100,000 population* U.S. Lags Other Countries: Mortality Amenable to Health Care Source: Adapted from E. Nolte and M. McKee, “Variations in Amenable Mortality—Trends in 16 High-Income Nations,” Health Policy, published online Sept. 12, 2011. The Bottom Line If the U.S. had achieved levels of amenable mortality seen in the three best-performing countries—France, Australia, and Italy —84,300 fewer people under age 75 would have died last year . Instead we focused on Rescue Care

8. WV HEALTH IMPROVEMENT INSTITUTE ADOPTION OF ELECTRONIC HEALTH RECORDS Develop proposed mechanisms to accelerate adoption of electronic health records in West Virginia MEASUREMENT Create a forum of alignment of measures across stakeholders to facilitate reporting SELF MANAGEMENT SUPPORT To align and improve access to resources and best practices to improve the self-activation capacity of all patients EDUCATION OF THE PROVIDER COMMUNITY To develop a system of provider engagement to accelerate Medicaid Transformation and assist physician practices with migration to AMH PAY FOR PERFORMANCE To provide guidance on the deployment of a P4P program as a model for the State QUALITY COLLABORATIONS To support a focused collaboration of key stakeholders on improving quality, building on past initiatives Member Education Healthy Rewards Advanced Medical Homes Advanced Medical Homes Pay 4 Performance Evidenced Based Medicine Health Information Systems Electronic Health Information Provider Technology Incentives OTHER RELEVANT INITIATIVES WV HIN – WVMI - OTHERS

9. Electronic Health Records “ A team approach to care…utilizing advanced information systems (including a standardized electronic health record); redesigned, more functional offices, and a whole-person orientation that focuses on quality, safety and care provided in a community context.” 129 Clinicians NCQA certified PCMH practices ( ZERO Morgantown) Advanced Medical Home

10. And Today in West Virginia Medical Homes Avoidable emergency room visits continue downward trend, seven percent better than market. Following evidence-based medicine continues to improve, six percentage points better than market. Medical cost trend is more than seven percentage points better than market. Diabetes is better controlled, will improve long-term health and lower medical costs.

11. Don’t handle your care needs in a BAD MEDICAL NEIGHBORHOOD!! Unaccountable care, lack of organization, DO NOT GO THERE ALONE!! Be wise when you pay for care, KNOW WHAT YOU BUY!! BEST HEART SURGERY !!!!

12. The Quadruple Aim = MU, PCMH & ACO Readiness, Experience of Care, Population Health, Cost Population Health System Integrator Patient Experience The System Integrator Creates a partnership across the medical neighborhood Drives PCMH primary care redesign Offers a utility for population health and Financial management Per Capita Cost Readiness

13. The Foundation for population health needs A long-term comprehensive relationship with a Personal Physician empowered with the right tools and linked to their care team.

15. If you scan the world for value based healthcare you will find a common element: a relationship-based team with a project manager! A comprehensivist that can command and control in an accountable system with DATA!! So simple! So much!

16. Powerful Engine for transformation Let me put this in WV terms… Compressive vs Episodic Integrated Accessible Coordinated “ Opportunities to expand access to primary care, build the health care workforce, and improve prevention and quality and attract jobs.” Improve the care of the population while controlling costs A “medical home” for patients, emphasizing primary care and make WV a business destination jobs . Community networks capable of managing recipient care with local systems that improve management of chronic illness in both rural and urban settings

18. Large Employers Partner With Medicaid CCNC New Game Changer “ Aug. 29 (Bloomberg) -- GlaxoSmithKline Plc is giving its privately insured U.S. workers PCMH level Care Via CCNC health-care network that uses primary care doctors to track patient use of specialists and hospitals. Community Care North Carolina Patient-Centered Medical Home model. It provides a comprehensive, team-based model of healthcare delivery. This model drives out variability by implementing standards for all aspects of primary care services. CCNC team ensures that care is all-inclusive and integrated with all other care provided within our system. Each patient will be assigned to a Medical Home, led by one’s primary care physician. The patient is a part of that team as well as a nurse educator, a care coordinator, and other support staff , all linked into and supporting the patient’s health.

22. Public Health Prevention Specialists PCMH in Action Vermont “Blueprint” model Community Care Team Nurse Coordinator Social Workers Dieticians Community Health Workers Care Coordinators Public Health Prevention HEALTH WELLNESS Hospitals PCMH PCMH Health IT Framework Global Information Framework Evaluation Framework Operations A Coordinated Health System Mental health PCMH

23. Vermont Financial Impact 2009 2010 2011 2012 2013 Percentage of Vermont population participating 6.7% 9.8% 13.0% 20.0% 40.0% Participating population 42,179 61,880 82,332 127,045 254,852 # Community Care Teams 2 3 4 6 13

29. CMS New Comprehensive Primary Care Initiative Risk-stratified care management : Primary care practices will be able to proactively assess their patients to determine their needs and provide appropriate and timely preventive care. Access and continuity: Primary care practices must be accessible to patients on a 24/7 basis Planned care for chronic conditions and preventive care Patient and caregiver engagement: Coordination of care across the medical neighborhood.

30. Where do you train the WV Workforce? There are examples of at least a few "high performing" Health Professional schools that support team based coordinated care delivery SELECT AND SUPPORT THESE … Requires a Smarter Healthcare Workforce OR ?