“Patient-Centered Medical Home (PCMH), What Do They Think We’ve Be Doing All These Years?”...
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![Page 1: “Patient-Centered Medical Home (PCMH), What Do They Think We’ve Be Doing All These Years?” Erik Southard DNP, FNP-BC.](https://reader036.fdocuments.in/reader036/viewer/2022062511/551c3e38550346a3488b4995/html5/thumbnails/1.jpg)
“Patient-Centered Medical Home (PCMH), What Do They Think We’ve
Be Doing All These Years?”Erik Southard DNP, FNP-BC
![Page 2: “Patient-Centered Medical Home (PCMH), What Do They Think We’ve Be Doing All These Years?” Erik Southard DNP, FNP-BC.](https://reader036.fdocuments.in/reader036/viewer/2022062511/551c3e38550346a3488b4995/html5/thumbnails/2.jpg)
Learning Objectives
• Understand the value of the PCMH initiative to “We the Patients”
• Review the goals of PCMH and the need for comprehensive medical care
• Define the components of the PCMH model• Establish realistic expectations and time lines
for implementation• Articulate what studies indicate the impact
PCMH will have on our system
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US Health Care Problems
• Fragmented• Inaccessible• Costly • Culturally ineffective
• “I got there and you know that doctor didn’t have any of my information.”
• “You know that clinic is never open when I need them.”
• “But I was just here last week.”
• “What is a Shaman anyway?”
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Problems Continued
• Burden is on patient and family
• Mediocre quality• Excessive use of high
cost services with marginal benefits.
• “We drove to three different pharmacies and none of them had the medication.”
• “I waited 45 minutes and she only spent five minutes with me.”
• “I’ve had laser treatment twice for my nail fungus and it came back.”
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National Health Expenditures 2010
• Hospital and physician/clinical services account for 51% of the $2.3 Trillion.
• Technology and prescription drug use.
• Rise in chronic diseases (75%).
Sources: 1Martin A.B. et al., “Growth In US Health Spending Remained Slow in 2010; Health Share of Gross Domestic Product Was Unchanged from 2009 ,”
Health Affairs, 20122Centers for Disease Control and Prevention. Rising Health Care Costs Are Unsustainable. April 2011.
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“What do they think we have been doing…..?”
• Medical home.• Term originated in 1967.• Care coordination dates back 1859.
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Current PCMH Status
• State Participation • National Participation
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PCMH Core Primary Care Goals
• Access• Patient Centered• Comprehensiveness• Coordination• Systems based approach to quality and safety
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Team Approach to Care
• Team members• Virtual team members
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Becoming a PCMH
• Human Capital • Dollars and sense’• Process
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Human Capital/PCMH Implementation
• Cultural Changes– Organized around the patient not the practice– Team based versus classic hierarchy approach– Change in patient habits– Work flow and system changes– Staff function at highest level – Removal of volume driven practice ideology– Significant human capital expense
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Dollars and Sense’
• Incremental cost estimates for the patient centered medical home
• Statistically significant increase in cost for information technology (IT) expenses2
• Average practice spent $8,000 in IT per FTE physician/provider
• There was not a statistically significant increase in any other cost component
4 S. Zuckerman, K. Merrell, R. Berenson et al., Incremental Cost Estimates for the Patient-Centered Medical Home, The Commonwealth Fund, October 2009.
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Process
• Appoint PCMH Director and send to training• After training director should:– Order the PCMH standards and guidelines (free)– Complete self-assessment – Meet with management and strategically select team
• Determine potential fee sponsors• Order online application and ISS survey tool*• Launch Online Application and Self Assess• Respond to Elements & attach documentation
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Time Frame to PCMH
• Short process, challenging endeavor• Change management • Two to three year process*• Some will never transform their practice to
PCMH level 3• Some will reach PCMH level 3 but will never
transform their practice
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Team Member Roles
• Director-coordinate and direct all PCMH activities• Primary Care Physician– Team Leader– Removed from volume driven practice
• NPs/PAs– Team leaders, health coaches, expanded practice roles
• Administrators– Facilitators for acquiring recognition and increased
payment
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Proposed Payment Model
• The American College of Physicians is advocating for a three part payment model.– A care coordination payment– Fee-for-service payment– Performance based component3
5 American College of Physicians. A System in Need of Change: Restructuring PaymentPolicies to Support Patient-Centered Care. Philadelphia: American College of Physicians;2006: Position Paper. (Available from American College of Physicians, 190 N. IndependenceMall West, Philadelphia, PA 19106.)
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Evidence-Based Movement
• Evidence on PCMH Effectiveness– Quality of Care– Cost of Care– Experience of Care
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Improving the Quality of Care
• Processes of Care– Lack of rigorous Studies– Three evaluations with rigorous methodology– Only one with favorable effects
• Health Outcomes– Only three evaluations with rigorous evidence– Two of those three found favor
• Mortality– Inconclusive but optimistic
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Costs of Care• Costs (Including the Intervention)– Four Rigorous Evaluations– Limited to high-risk subgroups– Mixed reviews
• Hospital Use– Five Rigorous Evaluations– One out of five indicated 18% reduction across risk
groups• Emergency Department Use– Three Rigorous Evaluations– One of three finding favorable effects
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The Experience of Care
• Patient and Caregiver Experience– Only three rigorous studies– Two with mostly favorable outcomes
• Healthcare Professional Experience– One lone evaluation with adequate rigor– Results were inconclusive
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Summative Review
• A guide to the medical home as a practice-level intervention6
6 Friedberg MW, Lai DJ, Hussey PS, Schneider EC. A guide to the medical home as a practice level intervention, Am J Manag Care. 2009; 15(10)(supl):S291-299.
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To PCMH or Not To PCMH
• Evidence with scientific rigor is scant.• Current evidence in favor of the medical home
is lacking.• More work to be completed, well
implemented and well conducted studies are needed.
• The cutting edge…..
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Closing RemarksPatient-centered medical home characteristics and staff morale in safety net clinics 6
6 Lewis, SE, Nocon, RS, Tang, H, Park, SY, Vable, AM, MV, Casalino, LP, Huang, ES, Quinn, MT, Burnet, DL, Summerfelt, WT, Birnberg, JM, Chin, MH. Patient-Centered Medical Home Characteristics and Staff Morale in Safety Net Clinics. Archives of Internal Medicine. 2012; 172(1)p23-31.