THE PATIENT-CENTERED MEDICAL HOME (PC-

MH): WHAT IS IT, WHY IS IT IMPORTANT, and WHO CARES?

STEVEN A. CRAWFORD, M.D.2007 CHAIR, AAFP COMMISSION ON

GOVERNMENTAL ADVOCACY

PROFESSOR & CHAIROU COLLEGE OF MEDICINE DEPARTMENT OF

FAMILY & PREVENTIVE MEDICINE

Hamster Health Care

Joseph E. Scherger, MD, MPH; ICSI/IHI Colloquium, May 18, 2007

Hamster Health Care

“Across the globe doctors are miserable because they feel like hamsters on a treadmill. They must run faster just to stand still…. The result of the wheel going faster is not only a reduction in the quality of care but also a reduction in professional satisfaction and burnout among doctors.”

Ian Morrison & Richard Smith. BMJ. 2000;321:1541-1542

Introduction

• WHAT IS THE PC-MH?• WHY IS IT IMPORTANT?• WHO CARES?• NEXT STEPS?

What is a PC-MH?

A PC-MH is a proposal by primary care physicians to organize care based on the Institute of Medicine’s definition of patient-centered care:

•

“providing care that is respectful of and responsive to individual patient

preferences, needs, values and ensuring that patient values guide all clinical

decisions”Institute of Medicine, Crossing the Quality Chasm: A New Health System for the 21st century, March 2001; Presentation to the Patient-Centered Primary Care Collaborative: Call-to-Action Summit; Bob Doherty, SVP, Governmental Affairs and Public Policy American College of Physicians

What is a PC-MH?

CORE FEATURES OF A MEDICAL HOME

• Personal Physician• Physician Directed Medical Practice• Whole Person Orientation• Care is Coordinated and/or

Integrated• Quality and Safety• Enhanced Access• Payment Reform Joint Principles of the patient-centered medical home.

www.medical-homeinfo.org/Joint%20Statement.pdf 10-24-07

WHY IS IT IMPORTANT?

• In the U.S., PCP supply is consistently associated with improved health outcomes for conditions like cancer, heart disease, stroke, infant mortality, low birth weight, life expectancy, and self-rated care.

• In England, each additional PCP per 10,000 persons is associated with an approximate decrease in mortality of 6%.

• In the U.K., an increase in PCP’s resulted in a significant decrease in both acute and chronic hospital admissions.Starfield B. Shi L, and Macinko J. Contributions of Primary Care to Health Systems and Health, Millbank

Quarterly, Vol. 83, No. 3, 2005 (457-502)

WHY IS IT IMPORTANT?

U.S. adults who reported having a PCP rather than a specialist as their regular source of care had lower 5 year mortality rates after controlling for initial differences in health status, demographics, health insurance status, health perceptions, reported diagnosis, and smoking status.

Starfield B. Shi L, and Macinko J. Contributions of Primary Care to Health Systems and Health, Millbank Quarterly, Vol. 83, No. 3, 2005 (457-502)

WHY IS IT IMPORTANT?

Patients who use a particular doctor for their care have more preventive care, more accurate diagnosis, fewer diagnostic tests, fewer prescriptions, fewer ER visits, and fewer hospitalizations, resulting in lower cost of care.

Starfield B. Shi L, and Macinko J. Contributions of Primary Care to Health Systems and Health, Millbank Quarterly, Vol. 83, No. 3, 2005 (457-502)

WHY IS IT IMPORTANT?

In the U.S., when adults have a medical home, access to needed care, receipt of routine preventive screenings, and management of chronic conditions improve substantially.

A. C. Beal, M. M. Doty, S. E. Hernandez, K. K. Shea, and K. Davis, Closing the Divide: How Medical Homes Promote Equity in Health Care: Results From The Commonwealth Fund 2006 Health Care Quality Survey, The Commonwealth Fund, June 2007

WHY IS IT IMPORTANT?

• North Carolina Medicaid enrolls recipients in a network of physician-directed medical homes

• External accounting suggests that North Carolina Medicaid saved $231 million over what would have been spent otherwise in 2005 and 2006

•Mercer Cost Effectiveness Analysis – AFDC only for Inpatient, Outpatient, ED, Physician Services, Pharmacy, Administrative Costs, Other). From presentation by Dobson, Al, Patient-Centered Primary Care Roundtable, March 12, 2007

WHY IS IT IMPORTANT?

Denmark• Organizes its entire health care

system around PC-MH• Achieve the highest patient

satisfaction ratings in the world• PCP’s are highly accessible &

supported by an outstanding IT system that assists in coordinating care

• Among the lowest per capita health expenditures & highest primary care rankings for Western nations

K. Davis, Learning From High Performance Health Systems Around the Globe, Invited Testimony: Senate Health, Education, Labor, and Pensions Committee Hearing "Health Care for All Americans: Challenges and Opportunities," January 10, 2007

WHO CARES?

• Consumers – YOU!!• Business Community• Provider Community• Payors• Advocacy Groups

WHO CARES?

Endorsed by…• The AAP, AAFP, ACP, and AOA,

representing approximately 333,000 physicians, publishes joint principles to describe the core features of the PC-MH

• The Patient-Centered Primary Care Collaborative, representing employers, physicians, consumers and health plans

WHO CARES?

• AARP• Bridges To Excellence• The ERISA Industry Committee• Exelon Corp• General Motors• IBM• McKesson Corporation• National Association of Community Health

Centers• National Business Group on Health• National Business Coalition on Health Care• National Committee for Quality Assurance• National Retail Federation

NEXT STEPS?

• Agree on a definitive statement of a PC – MH proposal

• Conduct education process• Buy-in by important players• Align system incentives for

behavior with desired goals• Develop a system of

documentation, accountability, transparency, and continuous-quality improvement

NCQA Scoring for PC-MH

Questions?

Patient-Centered Primary Care Collaborative: www.pcpcc.net/