World Health Summit Singapore April 2013

1. Patient Centered Medical Home
Paul Grundy MD, MPH
IBM‘s Director Healthcare Transformation
New York, USA
Pgrundy@us.ibm.com

2. Away from Episode of Care
to Management of Population
Population Per
Health Capita
Cost
System Integrator
Patient Productivity
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

3. Smarter Healthcare
36.3% Drop in hospital days
32.2% Drop in ER use
12.8% Increase Chronic Medication use
-15.6% Total cost
10.5% Inpatient specialty care costs 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 - PCPCC Oct 2012

4. “We do the best
heart surgeries.”
“How to Stop Hospitals From Killing Us” WSJ - 21 Sept 2012
“Bitter pill: The cost of health care” - Time - 23 Feb 2013

5. WellPoint PCMH Preliminary Year 2 Highlights In Sept
Issue Health affairs 2012
• 18% decrease in acute IP admissions/1000,
compared to 18% increase in control group
Colorado • 15% decrease in total ER visits/1000, compared to
4% increase in control group
• Specialty visits/1000 remained around flat
compared to 10% increase in control group
NEW HAMPSHIRE
• Overall Return on Investment estimates
ranged between 2.5:1 and 4.5:1
New York

7. Practice transformation away from episode of care
Preventive Chronic Disease Medication
Medicine Monitoring Refills Acute Care Test Results
DOCTOR
Case Behavioral Medical
Master Builder
Manager Health Assistants Nursing
Source: Southcentral Foundation, Anchorage AK

8. Healthcare will Transform
• Data Driven
• Every patient has a plan
• Team based

9. Defining the Care Centered on Patient
Superb Access
to Care Team Care
Patient Engagement
in Care Patient Feedback
Clinical Information
Systems, Registry
Publicly Available
Information
Care Coordination

10. 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”

11. Benefit Redesign - Patient Engagement Different Strategies for
Different Healthcare Spend Segments
Those with
severe, acute
illness or injuries
Those with
% Total chronic illness
Healthcare Those who are well or
think they are well
Spend
% of Members
11
11

12. PCMH in Action
A Coordinated
Health System
Hospitals Community Care Team Health IT
Nurse Coordinator Framework
PCMH Social Workers
Dieticians Global Information
Community Health Workers Framework
Specialists
Care Coordinators
Evaluation
PCMH Public Health Prevention Framework
HEALTH WELLNESS
Public Health Operations
Prevention
Copyright 2011 by IBM
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13. Why the Medical Home Works: A Framework
Feature Definition Sample Strategies Potential Impacts
Supports patients in learning to • Additional staff positions to help patients navigate
manage and organize their own care the system and fulfill care plans (e.g., care Patients are more likely to seek
at the level they choose, and ensures coordinators, patient navigators, social workers) the right care, in the right place,
Patient-Centered that patients and families are fully • Compassionate and culturally sensitive care and at the right time.
informed partners in health system • Strong, trusting relationships with physicians and
transformation at the practice, care team, and open communication about
community, and policy levels. decisions and health status
• Care team focuses on ‘whole person’ and Patients are less likely to seek care
A team of care providers is wholly from the emergency room or
population health
accountable for a patient’s physical
Comprehensive and mental health care needs,
• Primary care is co-located with oral, vision, hospital, and delay or leave
OB/GYN, pharmacy and other services conditions untreated
including prevention and wellness,
• Special attention paid to chronic disease and
acute care, and chronic care.
complex patients
Providers are less likely to order
• Care is documented and communicated effectively duplicate tests, labs, or
Ensures that care is organized across
across providers and institutions, including
all elements of the broader health procedures
patients, primary care, specialists, hospitals, home
Coordinated care system, including specialty care,
health, etc.
hospitals, home health care, and
• Communication and connectedness is enhanced by
community services and supports.
health information technology
Better management of chronic
diseases and other illness
improves health outcomes
Delivers consumer-friendly services • Implement more efficient appointment systems
with shorter wait-times, extended that offer same-day or 24/7 access to care team
Accessible hours, 24/7 electronic or telephone • Use of e-communications and telemedicine to
access, and strong communication provide alternatives for face-to-face visits and Focus on wellness and prevention
through health IT innovations. allow for after hours care. reduces incidence / severity of
chronic disease and illness
• Use electronic health records and clinical decision
Demonstrates commitment to quality
Committed to improvement through the use of
support to improve medication management,
treatment, and diagnosis.
quality and health IT and other tools to ensure
• Establish quality improvement goals to maximize
Health care dollars saved from
that patients and families make reductions in use of ER, hospital,
safety informed decisions about their health.
data and reporting about patient populations and
test, procedure, & prescriptions.
monitor outcomes