Patient Centered Medical Home Grand Rounds presentation

1. Steven R. Peskin, MD, MBA, FACP
EVP and Chief Medical Officer,
MediMedia USA
Assistant Clinical Professor, UMDNJ
Patient-Centered Primary Care Model
February 9, 2010

2. Presentation Overview
 The Need
 Key Elements of Patient Centered Medical Home
 ACP Medical Home Builder
 Demonstration Projects
 Discussion

3. The Need

4. Average spending on health
How do you start to fix the per capita ($US PPP)
foundational issue around why 7000
United States
our healthcare system is so Germany
expensive and yet so broken?? Canada
6000 France
Australia
United Kingdom
5000
4000
3000
2000
1000
0
80
82
84
86
88
90
92
94
96
98
00
02
04
19
19
19
19
19
19
19
19
19
19
20
20
20
Source: K. Davis, C. Schoen, S. Guterman, T. Shih, S. C. Schoenbaum, and I. Weinbaum,
Slowing the Growth of U.S. Health Care Expenditures: What Are the Options?, The
Commonwealth Fund, January 2007, updated with 2007 OECD data

5. ―We do heart surgery more often than anyone, but we
need to, because patients are not given the kind of (1)
coordinated primary care that would prevent chronic
heart disease from becoming acute.‖
George Halverson’s (CEO Kaiser)
Healthcare Reform Now

6. Need for a New Healthcare Delivery Model
 Increasing costs
– Healthcare costs are growing faster than the economy and the
cost of care is becoming difficult for employers, government and
individuals to meet.
 Need to improve quality
– Patients receiving recommended treatment 55 % of the time
– Poor U.S. performance on healthcare benchmarks compared to
other developed countries despite spending more.
 Regional variation
– Healthcare cost and quality vary substantially among geographic
regions. Little relationship between cost and quality.

7. Need for a New Healthcare Delivery Model
 Inadequate response to chronic care needs
– Increasingly aging and chronically ill population with payment
system that doesn’t recognize services found necessary for
essential care e.g. care coordination, evidence-based population
management, disease self management
 Decreased Interest in Primary Care
– The number of new students entering into primary care is
decreasing and physicians who have chosen the field are
disproportionately leaving compared to other specialties.
– Both domestic and international data indicating that higher
proportion of primary care physicians related to higher healthcare
quality and lower costs.

8. Key Elements of Patient Centered
Medical Home

9. A Joint Proposed Solution
The Patient-Centered Medical Home (PCMH)
 Modern ―medical home‖ concept originally in Pediatric literature in
the 1960’s—a central source of care for ―Special Needs‖ children.
 AAFP—Future of Family Medicine Project (2004) ―Personal
Medical Home‖
 ACP—Advanced Medical Home (2006)
 Key elements of a PCMH are described in a March 2007 joint
statement of principles from ACP, AAFP, AAP and AOA. Often
referred to as the ―Joint Principles‖.
 Nexus of patient-centered care, primary care and chronic care
model concepts

10. The Patient-Centered Medical Home
 Redesigns clinical delivery and payment to facilitate
– Patient-centered, longitudinal, coordinated care delivered by a
―recognized‖ practice with a personal physician
– Who accepts responsibility for the patient’s ―whole person‖
– Who acts in partnership with patients and in collaboration with
multidisciplinary teams (nurses, physician specialists, health
educators, pharmacists)
– Who uses practice level systems to improve access and
communication, care integration, patient safety and outcomes
– Who accepts accountability for care provided through on-going
performance measurement and quality improvement.

11. A New Model of Care that Redesigns
the Way Primary Care is Delivered and Financed
Patient Personal Physician
 Trusted personal physician
 Enhanced payment that recognizes the added value
 Physician who provides, manages and facilitates care of delivering care through the PCMH model
 Care is coordinated or integrated across healthcare  Assistance to practices seeking transformation
system
 Support to practices adopting HIT for QI
 More accessible practice with increased hours and
easier scheduling

12. Not Defined by any Certain Specialty
Patient Personal Physician

13. Physician as Facilitator, Not a Gatekeeper
Patient Personal Physician
Specialist Care Pharmacist Care
Hospital Care

14. (5) Changes in Clinician Incentives
Improved Patient Interaction
Blended Payment Better Work Environment
Fee For Service  More time for patients
 Fee for service  Team effort
 Better communication
 Prospective payment  Increased responsibility
for admin and clinicians and access
 Pay for outcomes
 Case management
Personal Physician

15. Nine Core Components
PPC 1: Access & Communication (9)
PPC 2: Patient Tracking & Registry Functions (21)
PPC 3: Care Management (20)
PPC 4: Patient Self-Management Support (6)
PPC 5: Electronic Prescribing (8)
PPC 6: Test Tracking (13)
PPC 7: Referral Tracking (4)
PPC 8: Performance Reporting & Improvement (15)
PPC 9: Advanced Electronic Communication (4)
TOTAL POINTS: 100

17. Physician Practice Connections – PCMH Levels
Level 3: 75+ Points; 10/10 Must Pass
Level 2: 50-74 Points; 10/10 Must Pass
Level 1: 25-49 Points; 5/10 Must Pass

19. Media Attention
Primary-care doctors and health system reformers
are predicting that a new way of providing health
care should provide better, cheaper results. The pay boost rewards doctors who reshape their
practices to recreate an era when a trusted family
The idea, called medical homes, combines physician helped patients through hospitalizations,
traditional notions of family physicians with coordinated specialist care and provided routine
modern technology. It has caught the attention screenings. Such efforts may save money by
of medical leaders, insurance companies and reducing hospitalizations, ER visits and disease.
politicians. – 7/14/2008
– 3/18/2008
Health policy experts say that unless payment and The resurgence of patient and purchaser interest
practice rules are changed, the financial squeeze in primary care is leading to the support of some
on primary care doctors threatens to a crisis for innovative practice models, largely outside the
patient care. academic health centers. One is the patient-
– 11/7/2007
centered medical home.
– 04/2008

20. The Patient-Centered Primary Care Collaborative
Examples of Broad Stakeholder Support & Participation
Providers
Purchasers –
333,000 primary care
Most of the Fortune 500
 ACP  AAP  IBM  General Motors
 AAFP  AOA  FedEx  General Electric
 ABIM  ACC  Pfizer  Microsoft
 ACOI  AHA  Business Coalitions
 Wal-mart
 AMA
The 80 Million lives
Patient-Centered
Medical Home
Payers Patients
 BCBSA  Aetna  NCQA  AFL-CIO
 United  Humana  National Partnership
for Women and Families
 CIGNA  HCSC
 Foundation for Informed
 WellPoint Decision Making
 SEIU

21. www.acponline.org/medicalhomebuilder

22. `

29. Key Characteristics
• National, credible, transparent resource
• Free for physicians and professional associations
• Ability to reach doctors in small and mid-sized
practices through their professional associations
• Create a Learning Community for health IT
• Target tools to three groups of healthcare
providers
– New adopters
– Current users wanting to transition to a new EHR
– Current users looking to optimize their EHR

30. Program Features
• AmericanEHRPartners.com - interactive online
community
• Educate and enable a wide range of physician needs
– Creation and aggregation of educational materials
– Users can search, display and compare appropriate EHR
solutions for their practice, specialty and certification type
– User ratings (i.e. surveys, online ratings) – Verified health
professionals
– Automated EHR selection process for RFI submissions & vendor
demonstrations
– Podcasts, blogs, newsletters, EHR Readiness Assessments and
other interactive tools
– Data dashboards - Professional associations, organizations and
physicians

31. MOCK UP OF
SITE
Readiness
Assessment
Comparison Tool
Auto-RFI
Implementation help
Learning network
Podcasts
Blogs/RSS Feeds
Specialty-society
info
Important links

32. Demonstration Projects

33. (Patient Centered Medical Home)
6% decrease in hospital admissions
24 % decrease emergency room
$500, Per member per years savings

34. Horizon Blue Cross Blue Shield/Partners In Care
For the New Jersey State Health Benefits Program

35. Results: Clinical Process Metric Improvement
HbA1c Testing
100
91%
75
50
25 43%
0
January November
2007 2007
Permission from Horizon Blue Cross Blue Shield and Partners in Care, Corp.

36. Lewisburg preTest period First pilot year Percent reduction
Pennsylvania Jan - Oct 2006 Jan – Oct 2007
Hospital 365/1000 291/1000 -20%
Admission
Hospital 15.2% 7.9% -48%
readmissions
Cost 7% less

38. Marillac’s Integrated Care Patients (PCMH)
25%
22%
20%
13%
15%
9%
10%
4%
5%
0%
Year 1 Year 2 Year 3 Year 4 Year 4.5
Hospitalization E.R. Visit

39. Overview of PCMH Commercial
Pilot Activity
• 22 projects
• 16 states
• 12 are Multi-stakeholder
• 10 are Insurer-based

40. Overview of PCMH Commercial
Pilot Activity (cont.)
Since October 2008:
• Alabama
New commercial • California
PCMH projects • Indiana
under • Maryland
development in • North Carolina
at least 8 more • Oklahoma
• Oregon
states:
• West Virginia
Additionally, new projects are under
development in the previous states,

41. Initiatives to Advance Medical Homes in
Medicaid/ SCHIP
= Identified to have a medical home initiative
Source: National Academy for State Health Policy
State Scan, November 2008

42. Combined Medical Home Activity

43. Discussion