Patient-Centered Medical Home Overview

October 15, 2013

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Employers Demanding More Value for Dollars

Spent on Healthcare

Information about Healthcare Cost and Quality is Improving

Employers Becoming More Adept at Pulling

Levers to Get Better Value

• Global competition• Aging workforce• High healthcare cost

structure• Increasing demand for

productive human capital

• HIT Proliferation via private and government investments

• Consumerism-driven cost and quality transparency

• Medicare data• Comparative

Effectiveness Research

• Wellness Incentives• Value-Based Insurance

Design– Prescription benefits– Medical benefits

• Centers of Excellence• Pay for performance

The Transitioning U.S. Marketplace

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• The PCMH model of care is associated with:

Better patient health outcomes

Higher patient satisfaction

Lower per-capita costs

• Financial support available in SC for PCMH practices

Monthly care coordination fees

Bonus incentives based on performance improvement

Financial rewards for seeking and achieving NCQA recognition

Guidance and support through the NCQA recognition process

Why PCMH?

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Same-day appointments for patients who need carePromotes continuity of care and helps patients avoid unnecessary use of the emergency room, retail clinics and urgent care centers.

Patients who have convenient access to their medical home are less likely to seek care from other providers

Benefits:• Reduces unnecessary use of the ER• Decreases patient use of retail clinics (fractured care) • Provides continuity of care which is associated with better health outcomes• Increases patient satisfaction

PCMH “Basics”

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Clinical team meetings (AKA “Daily Huddles”)• Care teams hold regular meetings to review upcoming

scheduled patient visits (“visit pre-planning”)

• Typically held daily, in advance of patient visits, and include the following activities:

Identifying gaps-in-care and establishing plans to address needs during visit

Review of specialist reportsReview of lab and imaging reports

Benefits: More robust patient visits

PCMH “Basics”

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Population management & proactive outreach

• The ability to identify groups of patients by condition and/or services needed

• Outreaching to patients who need care (letters, phone calls)

Benefits: • Prevents inactive patients from “falling through the

cracks”• Improves performance on clinical measures

PCMH “Basics”

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Collaborating with patients and families to develop care plans • Providing patients with a written/electronic copy of their

care plans and treatment goals• Providing education, tools and resources to help patients

better manage their conditions • Tracking goals and progress with patients at each

relevant visit• Assessing and addressing barriers when patients are not

meeting their goals

PCMH “Basics”

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Referral and test tracking

Formalized processes for tracking referrals and tests to ensure:

Results and reports are received timelyAbnormal results are reviewed by cliniciansResults are shared with patients

 Benefits:- Safety!- Prevents “lost” results

PCMH “Basics”

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Continuous Quality ImprovementCapturing data that can be used to track performance on important measures such as:

Patient satisfaction Clinical measures (diabetic A1Cs, LDLs, annual eye & foot

exams, etc.) Preventive measures (physical exams, immunizations,

mammograms, etc.)

Having access to useful and accurate data helps practices identify areas for improvement AND measure the success of improvement activities.

Benefits: Improved performance

PCMH “Basics”

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Lessons Learned

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Successful recognition doesn’t guarantee a successful PCMH.

Identify current problems in your practice and seek to solve them through your PCMH transformation.

Apply “R & D” techniques, wherever possible (Rip Off and Duplicate)

Having at least one engaged physician leader within the practice is critical to success

Change is practice-wide involving all staff working as a team and at the top of their license

Successful transformation leads to improved physician and staff satisfaction

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And, most importantly…

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PCMH isn’t just for large practice systems! Smaller practices are more nimble

Not as many layers of decision-makers (fewer people to disagree!)

Can define goals more quickly

Communicate more easily