Newzealand march 2014
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The document discusses quality primary care and reducing healthcare costs through the patient centered medical home (PCMH) model. It provides examples of how greater use of technology, care coordination, and evidence-based guidelines in primary care through the PCMH model has led to lower costs through reductions in emergency room visits, hospitalizations, and medical testing in the US and New Zealand. The PCMH model emphasizes proactive, team-based care coordinated around patient needs rather than episodic visits.
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Newzealand march 2014
- 1. © 2014 IBM Corporation Smarter Care Paul Grundy MD, MPH - IBM Director, Healthcare Transformation March, 2014 Quality Primary Care. Reducing Costs, Improving Care Patient Centered Medical Home
- 2. © 2014 IBM Corporation 2 Smarter Care GP Uptake of I.T. in New Zealand 0 20 40 60 80 100 1994 1997 2000 2003 Year PercentageofGPs GP Computer Use EDI Network Subscriptions Clinical Use of Internet
- 3. © 2014 IBM Corporation 3 Smarter Care What's the Point Just this -- NZ with its connected health care is the start of the future of Care Management. The basic technology on the Emerging CM Road. Emerging CM Models • Optimize patient health status & clinical outcomes • Save $$ long term for payor or patient • Health care consumerism/ patient empowerment • 100+ conditions/diseases • Done “by” the patient • Care coordinator = patient or doctor • Not geographically bound • Assembly from components viable • Technology intense
- 4. © 2014 IBM Corporation 4 Smarter Care Population Health Population Health System Integrator Patient Experience 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 Per Capita Cost Public Health Public Health Hospital Community Health Away from episode of care to management of population
- 5. © 2014 IBM Corporation 5 Smarter Care Give me enough medals and I'll win you any war' Napoleon Bonaparte – not just the $Green$ that brings JOY The Science of Rewards, incentives
- 6. © 2014 IBM Corporation 6 Smarter Care • 19.1% lower rate of adult hospitalization • 8.8% lower rate of adult ER visits. • 17.7% lower rate of child ER visits (under age 17) • 7.3% lower rate of adult high-tech radiology usage http://www.crainsdetroit.com/article/20130811/NEWS/308119989/blue- cross-touts-155-million-in-savings-with-medical-home-project http://www.crainsdetroit.com/article/20130811/NEWS/308119989/blue- cross-touts-155-million-in-savings-with-medical-home-project PCMH Michigan: August 11, 2013 Medical home physicians help patients avoid ERs and admissions by evening hour appointments, weekend and same-day appointments Versus other non-PCMH designated primary care physicians. 3,017 Physicians
- 7. © 2014 IBM Corporation 7 Smarter Care Rural New York Costs for Medicaid patients dropped from $334 to $266, according to a recent “risk adjusted” analysis. http://poststar.com/news/local/medical-home-program-gains- traction/article_5811380c-2ee9-11e3-8548-001a4bcf887a.html
- 8. © 2014 IBM Corporation 8 Smarter Care Today’s Care PCMH Care My patients are those who make appointments to see me My patients are those who make appointments to see me Our patients are the population community Our patients are the population community Care is determined by today’s problem and time available today Care is determined by today’s problem and time available today Care is determined by a proactive plan to meet patient needs with or without visits Care is determined by a proactive plan to meet patient needs with or without visits Care varies by scheduled time and memory or skill of the doctor Care varies by scheduled time and memory or skill of the doctor Care is standardized according to evidence-based guidelines Care is standardized according to evidence-based guidelines Patients are responsible for coordinating their own care Patients are responsible for coordinating their own care A prepared team of professionals coordinates all patients’ care A prepared team of professionals coordinates all patients’ care I know I deliver high quality care because I’m well trained I know I deliver high quality care because I’m well trained We measure our quality and make rapid changes to improve it We measure our quality and make rapid changes to improve it It’s up to the patient to tell us what happened to them It’s up to the patient to tell us what happened to them We track tests & consultations, and follow-up after ED & hospital We track tests & consultations, and follow-up after ED & hospital Clinic operations center on meeting the doctor’s needs Clinic operations center on meeting the doctor’s needs A multidisciplinary team works at the top of our licenses to serve patients A multidisciplinary team works at the top of our licenses to serve patients Slide from Daniel Duffy MD School of Community Medicine Tulsa Oklahoma
- 9. © 2014 IBM Corporation 9 Smarter Care Superb Access to Care Patient Engagement in Care Clinical Information Systems, Registry Care Coordination Team Care Communication Patient Feedback Mobile easy to use and Available Information Defining the Care Centered on Patient
- 10. © 2014 IBM Corporation 10 Smarter Care Trajectory to Value Based Purchasing: Achieving Real Care Coordination and Outcome Measurement Source: Hudson Valley Initiative
- 11. © 2014 IBM Corporation 11 Smarter Care 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”
- 12. © 2014 IBM Corporation 12 Smarter Care % Total Healthcare Spend % of Members Those who are well or think they are well Those with chronic illness Those with severe, acute illness or injuries Benefit Redesign - Patient Engagement Different Strategies for Different Healthcare Spend Segments
- 13. © 2014 IBM Corporation 13 Smarter Care Public Health Prevention Specialists PCMH 2.0 in Action 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 35
- 14. © 2014 IBM Corporation 14 Smarter Care Three key aspects of Smarter Care coordination Provide holistic, individualized care Collaborate for better outcomes Orchestrate and integrate across the enterprise and community
- 15. © 2014 IBM Corporation 15 Smarter Care Preventive Medicine Medication Refills Acute Care Nursing Test Results Master Builder DOCTOR Source: Southcentral Foundation, Anchorage AK Behavioral Health Case Manager Medical Assistants Chronic Disease Monitoring Practice transformation away from episode of care
- 16. © 2014 IBM Corporation 16 Smarter Care Medication Refills Chronic Disease Monitoring Test Results Acute Care Preventive Medicine Point of Care Testing Acute Mental Health Complaint Chronic Disease Compliance Barriers Healthcare Support Team Behavioral Health Medical Assistants Case Manager Provider Source: Southcentral Foundation, Anchorage AK PCMH Parallel Team Flow Design: the glue is real data, not a doctor’s brain
- 17. © 2014 IBM Corporation 17 Smarter Care 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 17
- 18. © 2014 IBM Corporation 18 Smarter Care Healthcare Will Transform Data Driven Every person has a plan Team based Managing a population down to the person .
- 19. © 2014 IBM Corporation 19 Smarter Care Thank you
- 20. © 2014 IBM Corporation 20 Smarter Care
- 21. © 2014 IBM Corporation 21 Smarter Care 21
- 22. © 2014 IBM Corporation 22 Smarter Care Trademarks and notes © IBM Corporation 2014 • IBM, the IBM logo, ibm.com, and Cúram are trademarks or registered trademarks of International Business Machines Corporation in the United States, other countries, or both. If these and other IBM trademarked terms are marked on their first occurrence in this information with the appropriate symbol (® or ™ ), these symbols indicate U.S. registered or common law trademarks owned by IBM at the time this information was published. Such trademarks may also be registered or common law trademarks in other countries. A current list of IBM trademarks is available on the Web at “Copyright and trademark information” at ibm.com/legal/copytrade.shtml. • Other company, product, and service names may be trademarks or service marks of others. • References in this publication to IBM products or services do not imply that IBM intends to make them available in all countries in which IBM operates.
Notas do Editor
- Key message: We are observing leaders across communities of care coming together to support common strategies and activities, focused on improved outcomes. We’re already seeing this happen, centered on a focus on the individual. And a focus on health and wellness -- rather than just acute care, where we know much of the cost is in the system today. Why are leaders / stakeholders coming together? They have common business interests, which can sometimes even result in acquisitions and consolidations. You can engage with that individual in a number of ways: Intervention -- where we can identify populations that have common characteristics, where an early intervention can actually improve outcomes, lower costs, prevent larger issues, and minimize future costs. Knowledge -- where we can do an assessment of what really works best based on evidence and standardized care planning; all of the external information that yields insight to patients/individuals and populations Collaboration -- where we really want to drive positive health choices, to bring together stakeholders – engaging with the individual, and family members -- to drive and monitor multifaceted care plans. Provide the individual with information and support to make healthy choices; collaborate across care providers and with the individual to ensure individualized care and informed choices. Coordination – where we are sharing information among and across stakeholders. Coordinating to share knowledge and expertise, sharing a common view of the progress from care plans. Coordinating to adapt or reassess plans and results. (think of meals on wheels, employers sponsored programs, social programs, care providers, home health, etc) Learning – Really important, because as we learn about how individuals and populations respond, we must continue to evolve. Through constant learning we are analyzing information, interactions, outcomes to guide more informed decisions -- to adapt and evolve best practices. Learning is a result of engaging with multiple individuals in a population and applying the new learning into future interactions and engagements. Ensuring the community of care keeps improving, continually making progress and refining approaches that drive optimal outcomes. Constant improvement and change, to deliver improved outcomes!