2C Grundy Extracting Value: Patient Centered Medical Home EHiN 2014
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Paul Grundy MD, MPH, IBM Director, Global Healthcare Transformation Extracting Value: Patient Centered Medical Home EHiN 2014, IKT-Norge og HOD
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2C Grundy Extracting Value: Patient Centered Medical Home EHiN 2014
- 1. Extracting Value Patient Centered Medical Home Paul Grundy MD, MPH - IBM Director, Healthcare Transformation @Paul_PCPCC https://twitter.com/Paul_PCPCC
- 2. Away from Episode of Care to Management of Population The System Integrator Creates a partnership across the medical neighborhood Drives PCMH primary care redesign Offers a utility for population health and financial management WITH DATA Population Health System Integrator Patient Experience Community Health Per Capita Cost Public Health @Paul_PCPCC https://twitter.com/Paul_PCPCC
- 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% Drop Inpatient specialty care costs 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. 24 July 2014 Michigan Blues’ patient-centered medical home program shows statewide transformation of care YEAR 6 •9.9 percent lower rate of adult ER visits •27.5 percent lower rate of adult ambulatory care sensitive inpatient stays •11.8 percent lower rate of adult primary care sensitive ER visits •8.7 percent lower rate of adult high-tech radiology usage •14.9 percent lower rate of pediatric ER visits •21.3 percent lower rate of pediatric primary-care sensitive ER visits 4,022 primary care doctors at 1,422 practices around the state in its sixth year of operation. These practices care for more than 1.2 million BCBSM members.
- 5. Beyond Flexner --- Driven by Actionable - Personalized Data
- 6. In much of the world, no one is in charge. And the result is the most wasteful and Unsustainable – BUT -where the delivery system works – a Patient in a trusting relation with a healer who is a comprehensivist with data is in charge”
- 7. USA 2012 Ogden UT
- 10. Practice transformation away from episode of 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
- 11. PCMH Parallel Team Flow Design: the glue is real data, not a doctor’s brain Chronic Disease Monitoring Medication Refills Test Results Acute Care Source: Southcentral Foundation, Anchorage AK Preventive Medicine Point of Care Testing Acute Mental Health Complaint Chronic Disease Compliance Barriers Healthcare Support Team Behavioral Health Medical Assistants Case Manager Clinician
- 12. Healthcare Will Transform --- Family Medicine for America’s Health Data Driven Every person has a plan Team based Managing a population down to the person .
- 13. Today’s Care PCMH Care My patients are those who make appointments to see me Our patients are the population community 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 varies by scheduled time and memory or skill of the doctor Care is standardized according to evidence-based guidelines Patients are responsible for coordinating their own care A prepared team of professionals coordinates all patients’ care I know I deliver high quality care because I’m well trained We measure our quality and make rapid changes to improve it It’s up to the patient to tell us what happened to them We track tests & consultations, and follow-up after ED & hospital Clinic operations center on meeting the doctor’s needs A multidisciplinary team works at the top of our licenses to serve patients Slide from Daniel Duffy MD School of Community Medicine Tulsa Oklahoma
- 14. Defining the Care Centered on Patient 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
- 15. Primary Care Capacity: Patient Centered Medical Home HIT Infrastructure: EHRs and Connectivity Operational Care Coordination: Embedded RN Coordinator and Health Plan Care Coordination $ Value/ Outcome Measurement: Reporting of Quality, Utilization and Patient Satisfaction Measures Value-Based Purchasing: Reimbursement Tied to Performance on Value (quality, appropriate utilization and patient satisfaction) Achieve Supportive Base for ACOs and Bundled Payments with Outcome Measurement and Health Plan Involvement Trajectory to Value Based Purchasing: Achieving Real Care Coordination and Outcome Measurement Source: Hudson Valley Initiative
- 16. 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”
- 17. Benefit Redesign - Patient Engagement Different Strategies for Different Healthcare Spend Segments % 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
- 18. Specialists Public Health Prevention 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 A Coordinated Health System Health IT Framework Global Information Framework Evaluation Framework Operations
- 19. Thank you
- 21. A comprehensive approach helps reduce costs while improving care INTERVENTION Identify and influence individuals and populations, and recognize intervention opportunities LEARNING Apply new insights from interactions and outcomes to enable continuous transformation COORDINATION KNOWLEDGE Drive evidence-based and standardized care planning Deliver care and monitor progress across clinical and social requirements COLLABORATION Assess and engage individuals and stakeholders to drive individualized care plans WELLNESS