Rutgers april 2014

© 2014 IBM Corporation

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Paul Grundy MD, MPH - IBM Director, Healthcare Transformation

March, 2014

Quality Primary Care. Reducing Costs, Improving CarePatient Centered Medical Home

© 2014 IBM Corporation 2

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Paul Grundy MD MPH Bio

• “Godfather” of the Patient Centered Medical Home• IBM Global Director Healthcare Transformation • President of PCPCC • Member Institute of Medicine• Member Board ACGME • Professor Univ. of Utah Department Family Medicine

• Winner NCQA national Quality Award • A Leader of MOH level taskforce primary care transformation 8

nations: USA, Canada, New Zealand, Australia, Holland, Denmark, UK, Belgium,

• Univ. of California MD, John Hopkins Trained


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Reengineering for Health Care

Three types of businesses undertake reengineering: • Those at the peak of their game & ambitious executives

• those that reengineer to stay ahead, and• those in deep trouble.

The US health care system is in trouble, and rather than single reforms, it needs and is getting reengineered.

•7 days to 4 hours # of deals increased a 100 foldJAMA - Feb 2013, Ari Hoffman, MD, Ezekiel J. Emanuel, MD, PhD


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PopulationHealth

System Integrator

PatientExperience

The System Integrator

Creates a partnership across the medical neighborhood

Drives PCMH primary care redesign

Offers a utility for population health and financial

management

Per Capita Cost

Public Health

Away from Episode of Care to Management of Population

Hospital Hospital

Community Health Community Health


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36.3% Drop in hospital days32.2% Drop in ER use12.8% 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

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Rural New York

Costs for Medicaid patients dropped from $334 to $266, according to a recent “risk

adjusted” analysis.

http://poststar.com/news/local/medical-home-program-gains-traction/article_5811380c-2ee9-11e3-8548-001a4bcf887a.html


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JAMA Article


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44% reduction in hospital costs

21% reduction in overall medical costs.

160 PCMH practices Pennsylvania from 2009 to 12

Number of patients with poorly controlled diabetes declined by 45% Jeffrey Bendix modernmedicine.com

44% reduction in hospital costs

21% reduction in overall medical costs.

160 PCMH practices Pennsylvania from 2009 to 12

Number of patients with poorly controlled diabetes declined by 45% Jeffrey Bendix modernmedicine.com

http://www.ajmc.com/publications/issue/2014/2014-vol20-n3/Medical-Homes-and-Cost-and-Utilization-Among-High-Risk-Patients#sthash.qR8uWb4t.dpuf

http://www.ajmc.com/publications/issue/2014/2014-vol20-n3/Medical-Homes-and-Cost-and-Utilization-Among-High-Risk-Patients#sthash.qR8uWb4t.dpuf

PCMH Pennsylvania March, 2013

Conclusions: PCMH practices had significantly reduced costs and utilization for the highest risk patients, particularly with respect to inpatient care.


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Ogden UT ,

USA 2012


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Smarter CareMobileFirst Patient Consumer


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Today’s Care PCMH Care

My patients are those who make appointments to see meMy patients are those who make appointments to see me

Our patients are the population community Our patients are the population community

Care is determined by today’s problem and time available todayCare 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 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 doctorCare varies by scheduled time and memory or skill of the doctor Care is standardized according to

evidence-based guidelinesCare is standardized according to evidence-based guidelines

Patients are responsible for coordinating their own carePatients are responsible for coordinating their own care

A prepared team of professionals coordinates all patients’ careA prepared team of professionals coordinates all patients’ care

I know I deliver high quality care because I’m well trainedI know I deliver high quality care because I’m well trained We measure our quality and make

rapid changes to improve itWe measure our quality and make rapid changes to improve it

It’s up to the patient to tell us what happened to themIt’s up to the patient to tell us what happened to them

We track tests & consultations, and follow-up after ED & hospitalWe track tests & consultations, and follow-up after ED & hospital

Clinic operations center on meeting the doctor’s needsClinic operations center on meeting the doctor’s needs

A multidisciplinary team works at the top of our licenses to serve patientsA multidisciplinary team works at the top of our licenses to serve patients

Slide from Daniel Duffy MD School of Community Medicine Tulsa Oklahoma


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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

Defining the Care Centered on Patient


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Trajectory to Value Based Purchasing: Achieving Real Care Coordination and Outcome Measurement

Source: Hudson Valley Initiative


Smarter CarePayment 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”

“fee for health” fee for value “fee for outcome”“fee for process” “fee for belonging“fee for service” “fee for satisfaction”


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Give me enough medals and I'll win you any war' Napoleon Bonaparte – not just the $Green$ that brings JOY

The Science of Rewards, incentives


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% 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

Benefit Redesign - Patient Engagement Different Strategies forDifferent Healthcare Spend Segments


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Public Health Prevention

Specialists

PCMH 2.0 in Action

Community Care Team

Nurse CoordinatorSocial Workers

DieticiansCommunity Health Workers

Care Coordinators

Public Health Prevention HEALTH WELLNESS

Hospitals

PCMH

PCMH

Health IT Framework

Global Information Framework

Evaluation Framework

Operations

A Coordinated Health System

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PreventiveMedicine

MedicationRefills Acute Care

Nursing

Test Results

Master Builder

DOCTOR

Source: Southcentral Foundation, Anchorage AK

BehavioralHealth

CaseManager

MedicalAssistants

Chronic DiseaseMonitoring

Practice transformation away from episode of care


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MedicationRefills

ChronicDisease

MonitoringTest

Results

AcuteCare

PreventiveMedicine

Point of Care Testing

Acute Mental Health

Complaint

ChronicDisease

ComplianceBarriers

HealthcareSupport

Team Behavioral Health

MedicalAssistants

CaseManager Provider

Source: Southcentral Foundation, Anchorage AK

PCMH Parallel Team Flow Design: the glue is real data, not a doctor’s brain


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Healthcare Will Transform

Data Driven

Every person has a plan

Team based

Managing a population down to the person

.


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Three key aspects of PCMH Smarter Care coordination

Provide holistic, individualized careProvide holistic, individualized care

Collaborate for better outcomesCollaborate for better outcomes

Orchestrate and integrate across the enterprise and community

Orchestrate and integrate across the enterprise and community


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1. Pursue Electronic Patient Management and engagement rather than Electronic Patient Records 2. Bring to bear upon every patient encounter what is known rather than what a particular provider knows. 3. Make it easier to do it right than not to do it at all. 4. Continuous performance improvement. 5. Infuse new knowledge and decision-making tools throughout an organization instantly.


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6. Establish and promote continuity of care with patient education, information and plans of care.

7. Enlist patients as partners and collaborators in their own health improvement.

8. Evaluate the care of patients and populations of patients longitudinally.

9. Audit provider performance based on the Consortium for Physician Performance Improvement Data Sets.

10. Create multiple case-management tools which are integrated in an intuitive and interchangeable fashion giving patients the benefit of expert knowledge about specific conditions while they get the benefit of a global approach to their total health


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Practices Features -- - Emphasis on care coordination and system navigation, System Integrator, PCMH role for family physician in integrated system - Big push on population health management - Care teams with PCP + a variety of other professions, e.g., nursing, pharmacy, public health and mental health.

Technology Use - Better population health data stemming from centralized data based EHR through integrated system. - Adoption of telemedicine, Establish Primary Care Technology Center (PCTC), a research and training entity, to fuel adoption of efficacious technology in practice, patient engagement tools. Modern, flexible, sophisticated system, developed in partnership with technology providers. -Multi-modal communication w/ patients .


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Building a Workforce -- Training in the use of population health management, data management and public health tools - Dual degrees – MD + MBAs, MPHs - .Add’l training in interprofessional collaboration, EHR data usage, and integrated practice management.

Research Focus -- Conclusive evidence about system wide quality improvement and cost savings of robust primary care.- Rise of Continuum-Based Research Networks, applied research efforts to improve clinical pathways. - Research builds case for reductions in Total Cost of Care (at system level), research into technologies most inpactful on Triple Aim. - FM becomes trusted source of best practices to meet Triple Aim, .Focus on issues that relate to patients owning their own health through patient experience and engagement research


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Collaboration -- - Family medicine’s partnership with payers and the integrated systems, to exchange ideas about how to best deploy family physicians and represent their colleagues’ interests to these systems - Subspecialists – to ensure great working relationships within systems. - Primary care professionals – to achieve the best possible outcomes in service of Triple Aim. Payers, particularly CMS – to ensure success of alternative payment pilots.- Primary Care Nurse Practitioners (to work together in pursuit of expanded role of Primary Care, Technology manufacturers) to provide advice on how to improve technology in use by FPs,

Key Investments -- Curricular overhaul and research effort to prepare residents for work in integrated systems, tools for data being made into actionable information in population management, advance clinical decision support


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Thank you


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A comprehensive approach helps reduce costs while improving care

Apply new insights from interactions and outcomes

to enable continuous transformation

LEARNING

Identify and influence individuals and populations, and recognize

intervention opportunities

INTERVENTION

COORDINATIONDeliver care and monitor progress

across clinical and social requirements

COLLABORATIONAssess and engage individuals and stakeholders to drive individualized care plans

Drive evidence-based andstandardized care planning

KNOWLEDGE

WELLNESS

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Trademarks and notes

© IBM Corporation 2014• IBM, the IBM logo, ibm.com, and Cúram are trademarks or registered trademarks of International Business

Machines Corporation in the United States, other countries, or both. If these and other IBM trademarked terms are marked on their first occurrence in this information with the appropriate symbol (® or ™), these symbols indicate U.S. registered or common law trademarks owned by IBM at the time this information was published. Such trademarks may also be registered or common law trademarks in other countries. A current list of IBM trademarks is available on the Web at “Copyright and trademark information” at ibm.com/legal/copytrade.shtml.

• Other company, product, and service names may be trademarks or service marks of others.• References in this publication to IBM products or services do not imply that IBM intends to make them available in all

countries in which IBM operates.

Rutgers april 2014

Healthcare

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