The document discusses the patient-centered medical home (PCMH) model and its potential benefits. It summarizes that the PCMH aims to provide patient-centered, coordinated care through a personal physician leading a team. Data from other countries shows primary care-focused systems have better outcomes and lower costs. The PCMH may benefit primary care physicians through payment reform recognizing care coordination work. It may benefit patients through improved access and chronic disease management support. Subspecialists may also benefit from opportunities to lead medical homes and fewer administrative hassles.

1. RPA 2009 Annual Meeting Jeffrey P. Harris, MD, FACP Patient Centered Medical Home March 23, 2009

4. Escalating Costs International Comparison of Spending on Health, 1980–2004 Data: OECD Health Data 2005 and 2006. Average spending on health per capita ($US PPP) Total expenditures on health as percent of GDP Source: Commonwealth Fund National Scorecard on U.S. Health System Performance, 2006 EFFICIENCY

5. Total outlays in billions Projected Medicare Outlays, 2008-2018 NOTE: Numbers have been rounded to nearest whole number. SOURCE: Kaiser Family Foundation, based on Congressional Budget Office, The Budget and Economic Outlook: An Update , January 2008. 16% 16% 16% 17% 17% 18% 18% 19% 20% 20% 20% 3% 3% 3% 3% 3% 3% 4% 4% 4% 4% 4% Share of: Federal Budget Gross Domestic Product

6. Medicare Beneficiaries and The Number of Workers Per Beneficiary Millions of beneficiaries Number of workers per beneficiary SOURCE: Kaiser Family Foundation, based on 2001 and 2008 Annual Reports of the Boards of Trustees of the Federal Hospital Insurance and Federal Supplementary Medical Insurance Trust Funds.

7. Commonwealth Fund National Scorecard on U.S. Health System Performance, 2006. www.commonwealthfund.org

8. Life Expectancy at Birth in 2005 Source: OEDC Data, 2007

9. Criteria : Overall Mission to Achieve Long, Healthy and Productive Lives Source: OEDC Data, 2007

10. USA: MORE ERRORS Deaths Due to Surgical or Medical Mishaps per 100,000 Population in 2004 a 2003 b 2002 a b b b b b Source: The Commonwealth Fund, calculated from OECD Health Data 2006. Cylus J and Anderson GF. Multinational Comparisons of Health Systems Data, 2006

12. Buyers’ remorse Statement of Peter R. Rosa. Director, Growth in Health Care Costs, Congressional Budget Office, before the Committee on the Budget United States Senate, January 31, 2008 www.cbo.gov/ftpdocs/89xx/doc8948/01-31-HealthcareSlides.pdf

14. States with red circles have PC/Specialty Ratio of < 1.0 States with green circles have PC/Specialty Ratio of >1.45 [In the last two years of life] Dartmouth atlas Quality/Cost Impact

15. Primary Care Score vs Health Care Expenditures 1997 Source: The Commonwealth Fund, Data from B. Starfield, “Why More Primary Care: Better Outcomes, Lower Costs, Greater Equity,” Presentation to the Primary Care Roundtable: Strengthening Adult Primary Care: Models and Policy Options, October 3, 2006. Quality/Cost Impact

16. OECD = Organization for Economic Cooperation & Development PYLL = Potential years of life lost

17. HPPC Examined Health Care in the USA and Systems in 12 Other Countries

23. Interest in Entering Primary Care has been Declining Among Graduating Seniors (Percentages 1999-2006) Source: Association of American Medical School Graduation Questionnaires http://www.aamc.org/data/gq/allschoolsreports/2006.pdf

24. Bodenheimer, T. et. al. Ann Intern Med 2007;146:301-306 The Primary Care—Specialty Income Gap

25. Patient-Centered, Physician-Guided Care Adapted from: Defining Primary Care: An Interim Report, Institute of Medicine 1994 Physician Patient Practice Family Team Integrated Community Delivery System or Virtual Team Core of Team-Based Care NP/PA RN/LPN Medical Assistant Care Coordinator Office Staff Nutritionist/Educator Pharmacist Behavioral Health Case Manager Community resources DM companies Others… Immediate family Extended family Friends Neighbors