1. PCMH STFM 2011 Paul Grundy, MD, MPH, FACOEM, FACPM IBM Director Healthcare TransformationPresident Patient Centered Primary Care Collaborative Paul Grundy MD, MPH IBM International Director Healthcare Transformation Trip to Denmark July 10 2009

2. Who was the Shooter’s Doctor? Population management Accountability

3. You Tube Video

4. Why Innovate Affordability $30,000 +166% $25,000 $20,000 $15,000 +118% $10,000 $4,918 $5,000 $0 2001 2009 2019 - Employee Payroll Contributions - Employer Cost - Employee Out of Pocket Expenses a The Elephant in the room $28,530 Costs continue their upward climb… …with employers still picking up much of the tab… $10,743

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!!” You the AHC’s - Unaccountable Care Organizations PART of this problem * Peter A. Muennig and Sherry A. Glied Health Affairs Oct. 7, 2010

6. Health care is a business issue, not a benefits issue

7. 3° Care 2° Care What’s wrong with this picture? 1° Care Every country starts at the base of the pyramid with primary care, and they work their way up until the money runs out. … “We start at the top of the pyramid, and we work our way down until the money runs out…And so we have to change the pyramid. We have to start at the base.” 3° Care 2° Care 1° Care

8. 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!!

9. Coordination -- we do NOT know how to play as a team “ We don't have a health care delivery system in this country. We have an expensive plethora of uncoordinated, unlinked, micro systems, each performing in ways that too often create sub-optimal performance, both for the overall health care infrastructure and for individual patients." George Halvorson, from “Healthcare Reform Now Saudi Arabia’s King Abdulaziz traveled to the U.S. to receive treatment slipped disc

10. “We do heart surgery more often than anyone, but we need to, because patients are not given the kind of coordinated primary care that would prevent chronic heart disease from becoming acute.” George Halvorson (CEO Kaiser) from “Healthcare Reform Now”

11. The most important tool - mind of the Family Physician focused on two things, relationship, Difficult diagnostic dilemmas A long-term comprehensive relationship with your Personal Physician empowered with the right tools and linked to your care team can result in better overall family health…

13. Physician directed medical practice – the personal physician leads a team of individuals at the practice level who collectively take responsibility for the ongoing care of patients

14. Whole person orientation – the personal physician is responsible for providing for all the patient’s health care needs or arranging care with other qualified professionals

15. Care is coordinated and integrated across all elements of the complex healthcare community- coordination is enabled by registries, information technology, and health information exchanges

17. The Quadruple AimReadiness, Experience of Care, Population Health, Cost Per Capita Cost Population Health The System Integrator Creates a partnership across the medical neighborhood Drives PCMH primary care redesign Offers a utility for population health and financial management System Integrator Patient Experience Productivity

19. You need a place of command and control

20. You need a horizontal platform from which to launch vertical weapon systems

22. Team-Based HealthcareDelivery Population Health Access to Care Patient is the centerof theMedical Home Advanced IT Systems Patient-Centered Care Decision Support Tools Refocused Medical Training Patient & Physician Feedback Enhancing Health and the Patient Experience Medical Home Model Model adapted from theNNMC Medical Home

23. Defining the Care Superb Access to Care Team Care Patient Engagement in Care Patient Feedback Clinical Information Systems Publically Available Information Care Coordination

24. Smarter Healthcare… 36.3% Drop in hospital days 32.2% Drop in ER use 9.6% Total cost 10.5% Inpatient specialty care costs are down 18.9% Ancillary costs down 15.0% Outpatient specialty down Outcomes of Implementing Patient Centered Medical Home Interventions: A Review of the Evidence from Prospective Evaluation Studies in the US, K. Grumbach & P. Grundy, November 16th 2010

26. Provide open scheduling.

27. Provide care management and coordination by specially-trained team members.

28. Use an EHR with decision support.

29. Use CPOE for all orders, test tracking, and follow-up.

30. Medication reconciliation for every visit.

31. Prescription drug decision support.

32. Implement e-prescribing.

33. Pre-visit planning and after-visit follow-up for care management.

34. Offer patient self-management support.

35. Provide a visit summary to the patient following each visit.

36. Maintain a summary-of-care record for patient transitions.

37. Email consultations.

38. Telephone consultations.

39. The development of care plans.

40. Performance outcome measures.

41. Trends this week Highmark Inc. Patient-Centered Medical Home Program Designed to Improve Coordination Adirondack Region Medical Home Pilot Somava Stout, MD, Vice President for Patient-Centered Medical Home Development at Cambridge Health Alliance (CHA), Horizon PCMH NJ (BCBS NJ) Army Screaming eagle PCMH

42. Corporate Concierge PCMH The private clinic is for the employees and Families on or near site From 10.2% to 23.7% of company care OneAmerica to Open PCMH Wellness Clinic Perdue opens 15th PCMH Central Louisiana Family Health and Wellness Center. Martin Companies and Gilchrist Construction Co and 23 other companies

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

44. Vermont Financial Impact Vermont Financial Impact

45. Sharp Community Medical Group: Care Transformation Model Accountable Community Accountable Care Organization Enterprise Level Activities Patient-Centered Medical Home Patient

46. PCMH is non-political – the right POV for delivery transformation “We never abandoned advocating new Models of care. We’ve long pushed folks to realize that Delivery reform is the key.” The patient-centered medical home is core. “We included the attached chapter on PCMH in our book. and have a new publication on ACOs coming out in January.”

47. OR? …Requires a Smarter Healthcare Workforce Where do you train the MHS Workforce?

49. Payment reform requires more than one method, you have dials, adjust them!!! fee for health” “fee for outcome” “fee for process” “fee for belonging “fee for service” “fee for satisfaction”

51. Enable Patients

52. Manage populations

53. Manage performance

54. Digitization & Interoperability

55. Identify gaps in care

56. Price / manage risk

58. Really engage your patients find out what they need and become very patient centered

59. Integrate value base purchasing with PCMH in your plan designee (understand what the buyer wants)

60. Stop teaching the past you are in a world of Data, teams, actionable information

61. Integrate Health and Sick care

62. GIVE US LEADERSHIP - SHOW US THE WAY!