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February 9, 2010
Patient-Centered Primary Care Model
Steven R. Peskin, MD, MBA, FACP
EVP and Chief Medical Officer,
MediMedia USA
Assistant Clinical Professor, UMDNJ
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Presentation Overview
The Need
Key Elements of Patient Centered Medical Home
ACP Medical Home Builder
Demonstration Projects
Discussion
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The Need
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How do you start to fix the
foundational issue around why
our healthcare system is so
expensive and yet so broken??
0
1000
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1980
1982
1984
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2000
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United States
Germany
Canada
France
Australia
United Kingdom
Average spending on health
per capita ($US PPP)
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
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―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
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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.
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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.
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Key Elements of Patient Centered Medical Home
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A Joint Proposed SolutionThe 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
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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.
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A New Model of Care that Redesigns
the Way Primary Care is Delivered and Financed
Patient Personal Physician
Trusted personal physician
Physician who provides, manages and facilitates care
Care is coordinated or integrated across healthcare system
More accessible practice with increased hours and
easier scheduling
Enhanced payment that recognizes the added value of delivering care through the PCMH model
Assistance to practices seeking transformation
Support to practices adopting HIT for QI
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Not Defined by any Certain Specialty
Personal PhysicianPatient
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Physician as Facilitator, Not a Gatekeeper
Specialist Care Pharmacist Care
Hospital Care
Personal PhysicianPatient
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(5) Changes in Clinician Incentives
Fee For Service Fee for service
Prospective payment
Pay for outcomes
Blended PaymentImproved Patient Interaction
Better Work Environment
Team effort
Increased responsibility for admin and clinicians
More time for patients
Better communication and access
Case management
Personal Physician
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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
Nine Core Components
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Physician Practice Connections – PCMH Levels
Level 1: 25-49 Points; 5/10 Must Pass
Level 2: 50-74 Points; 10/10 Must Pass
Level 3: 75+ Points; 10/10 Must Pass
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Media Attention
The resurgence of patient and purchaser interest in primary care is leading to the support of some innovative practice models, largely outside the academic health centers. One is the patient-centered medical home.
– 04/2008
Health policy experts say that unless payment and practice rules are changed, the financial squeeze on primary care doctors threatens to a crisis for patient care.
– 11/7/2007
Primary-care doctors and health system reformers are predicting that a new way of providing health care should provide better, cheaper results.
The idea, called medical homes, combines traditional notions of family physicians with modern technology. It has caught the attention of medical leaders, insurance companies and politicians.
– 3/18/2008
The pay boost rewards doctors who reshape their practices to recreate an era when a trusted family physician helped patients through hospitalizations, coordinated specialist care and provided routine screenings. Such efforts may save money by reducing hospitalizations, ER visits and disease.
– 7/14/2008
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The Patient-Centered Primary Care Collaborative
ACP
Providers
333,000 primary care
Purchasers –
Most of the Fortune 500
Payers Patients
AAP
AAFP AOA
ABIM ACC
ACOI
AMA
AHA
IBM General Motors
General Electric FedEx
Microsoft Pfizer
Wal-mart
Business Coalitions
BCBSA
United
Aetna
CIGNA
Humana
WellPoint
HCSC
NCQA AFL-CIO
National Partnership for Women and Families
SEIU
Foundation for Informed Decision Making
Examples of Broad Stakeholder Support & Participation
The
Patient-Centered
Medical Home
80 Million lives
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`
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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
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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
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Readiness
Assessment
Comparison Tool
Auto-RFI
Implementation help
Learning network
Podcasts
Blogs/RSS Feeds
Specialty-society
info
Important links
MOCK UP OF
SITE
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Demonstration Projects
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(Patient Centered Medical Home)
6% decrease in hospital admissions
24 % decrease emergency room
$500, Per member per years savings
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Horizon Blue Cross Blue Shield/Partners In Care
For the New Jersey State Health Benefits Program
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Results: Clinical Process Metric Improvement
HbA1c Testing
91%
43%0
25
50
75
100
January
2007
November
2007
Permission from Horizon Blue Cross Blue Shield and Partners in Care, Corp.
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Lewisburg
Pennsylvania
preTest period
Jan - Oct 2006
First pilot year
Jan – Oct 2007
Percent reduction
Hospital
Admission
365/1000 291/1000 -20%
Hospital
readmissions
15.2% 7.9% -48%
Cost 7% less
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9%
4%
22%
13%
0%
5%
10%
15%
20%
25%
Year 1 Year 2 Year 3 Year 4 Year 4.5
Hospitalization E.R. Visit
Marillac’s Integrated Care Patients (PCMH)
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Overview of PCMH Commercial Pilot Activity
• 22 projects
• 16 states
• 12 are Multi-stakeholder
• 10 are Insurer-based
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Overview of PCMH Commercial Pilot Activity (cont.)
Since October 2008:
• Alabama
• California
• Indiana
• Maryland
• North Carolina
• Oklahoma
• Oregon
• West Virginia
New commercial PCMH projects
under development in at least 8 more
states:
Additionally, new projects are under
development in the previous states,
such as Colorado (Family Medicine
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= Identified to have a medical home initiative
Source: National Academy for State Health Policy
State Scan, November 2008
Initiatives to Advance Medical Homes in
Medicaid/ SCHIP
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Combined Medical Home Activity
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Discussion