2c grundy extracting value: patient centered medical home ehin 2014
DESCRIPTION
Paul Grundy MD, MPH, IBM Director, Global Healthcare Transformation Extracting Value: Patient Centered Medical Home EHiN 2014, IKT-Norge og HODTRANSCRIPT
![Page 1: 2C Grundy Extracting Value: Patient Centered Medical Home EHiN 2014](https://reader033.vdocuments.site/reader033/viewer/2022052508/5594c9211a28abcc3c8b45c7/html5/thumbnails/1.jpg)
Extracting Value
Patient Centered Medical Home
Paul Grundy MD, MPH - IBM Director, Healthcare Transformation
@Paul_PCPCChttps://twitter.com/Paul_PCPCC
![Page 2: 2C Grundy Extracting Value: Patient Centered Medical Home EHiN 2014](https://reader033.vdocuments.site/reader033/viewer/2022052508/5594c9211a28abcc3c8b45c7/html5/thumbnails/2.jpg)
The System Integrator
Creates a partnership across the medical neighborhood
Drives PCMH primary care redesign
Offers a utility for population health and financial management
Away from Episode of Care to Management of PopulationWITH DATA
Community Health
PopulationHealth
System Integrator
PatientExperience
Per Capita Cost
Public Health
@Paul_PCPCChttps://twitter.com/Paul_PCPCC
![Page 3: 2C Grundy Extracting Value: Patient Centered Medical Home EHiN 2014](https://reader033.vdocuments.site/reader033/viewer/2022052508/5594c9211a28abcc3c8b45c7/html5/thumbnails/3.jpg)
36.3% Drop in hospital days
32.2% Drop in ER use
12.8% 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
Smarter Healthcare
![Page 4: 2C Grundy Extracting Value: Patient Centered Medical Home EHiN 2014](https://reader033.vdocuments.site/reader033/viewer/2022052508/5594c9211a28abcc3c8b45c7/html5/thumbnails/4.jpg)
•9.9 percent lower rate of adult ER visits
•27.5 percent lower rate of adult ambulatory care sensitive
inpatient stays
•11.8 percent lower rate of adult primary care sensitive ER
visits
•8.7 percent lower rate of adult high-tech radiology usage
•14.9 percent lower rate of pediatric ER visits
•21.3 percent lower rate of pediatric primary-care sensitive ER
visits
24 July 2014 Michigan Blues’ patient-centered medical home program
shows statewide transformation of care YEAR 6
4,022 primary care doctors at 1,422 practices around the state
in its sixth year of operation. These practices care for more
than 1.2 million BCBSM members.
![Page 5: 2C Grundy Extracting Value: Patient Centered Medical Home EHiN 2014](https://reader033.vdocuments.site/reader033/viewer/2022052508/5594c9211a28abcc3c8b45c7/html5/thumbnails/5.jpg)
Beyond Flexner --- Driven by Actionable - Personalized Data
![Page 6: 2C Grundy Extracting Value: Patient Centered Medical Home EHiN 2014](https://reader033.vdocuments.site/reader033/viewer/2022052508/5594c9211a28abcc3c8b45c7/html5/thumbnails/6.jpg)
– BUT -where the delivery system works – a Patient in a trusting relation with a healer who is a comprehensivist with data is in charge”
In much of the world, no one is in charge. And the result is the most wasteful and Unsustainable
![Page 7: 2C Grundy Extracting Value: Patient Centered Medical Home EHiN 2014](https://reader033.vdocuments.site/reader033/viewer/2022052508/5594c9211a28abcc3c8b45c7/html5/thumbnails/7.jpg)
USA 2012
Ogden UT
![Page 8: 2C Grundy Extracting Value: Patient Centered Medical Home EHiN 2014](https://reader033.vdocuments.site/reader033/viewer/2022052508/5594c9211a28abcc3c8b45c7/html5/thumbnails/8.jpg)
![Page 9: 2C Grundy Extracting Value: Patient Centered Medical Home EHiN 2014](https://reader033.vdocuments.site/reader033/viewer/2022052508/5594c9211a28abcc3c8b45c7/html5/thumbnails/9.jpg)
MobileFirst Patient Consumer
![Page 10: 2C Grundy Extracting Value: Patient Centered Medical Home EHiN 2014](https://reader033.vdocuments.site/reader033/viewer/2022052508/5594c9211a28abcc3c8b45c7/html5/thumbnails/10.jpg)
PreventiveMedicine
MedicationRefills Acute Care
Nursing
Test Results
Master Builder
DOCTOR
Source: Southcentral Foundation, Anchorage AK
Behavioral
Health
Case
ManagerMedical
Assistants
Chronic Disease
Monitoring
Practice transformation away from episode of care
![Page 11: 2C Grundy Extracting Value: Patient Centered Medical Home EHiN 2014](https://reader033.vdocuments.site/reader033/viewer/2022052508/5594c9211a28abcc3c8b45c7/html5/thumbnails/11.jpg)
Source: Southcentral Foundation, Anchorage AK
PCMH Parallel Team Flow Design: the glue is real data, not a doctor’s brain
Medication
Refills
Chronic
Disease
Monitoring
Test
Results
Acute
Care
Preventive
Medicine
Point of
Care Testing
Acute
Mental
Health
Complaint
Chronic
Disease
Compliance
Barriers
Healthcare
Support
Team Behavioral
Health
Medical
Assistants
Case
Manager Clinician
![Page 12: 2C Grundy Extracting Value: Patient Centered Medical Home EHiN 2014](https://reader033.vdocuments.site/reader033/viewer/2022052508/5594c9211a28abcc3c8b45c7/html5/thumbnails/12.jpg)
Healthcare Will Transform --- Family Medicine for America’s Health
Data Driven
Every person has a plan
Team based
Managing a population down to the person
.
![Page 13: 2C Grundy Extracting Value: Patient Centered Medical Home EHiN 2014](https://reader033.vdocuments.site/reader033/viewer/2022052508/5594c9211a28abcc3c8b45c7/html5/thumbnails/13.jpg)
Today’s Care PCMH Care
My patients are those who make appointments to see
me
Our patients are the population community
Care 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 varies by scheduled time and memory or skill of
the doctor
Care is standardized according to evidence-based
guidelines
Patients are responsible for coordinating their own
care
A prepared team of professionals coordinates all
patients’ care
I know I deliver high quality care because I’m well
trained
We measure our quality and make rapid changes to
improve it
It’s up to the patient to tell us what happened to them
We track tests & consultations, and follow-up after
ED & hospital
Clinic operations center on meeting the doctor’s
needs
A multidisciplinary team works at the top of our
licenses to serve patients
Slide from Daniel Duffy MD School of Community Medicine Tulsa Oklahoma
![Page 14: 2C Grundy Extracting Value: Patient Centered Medical Home EHiN 2014](https://reader033.vdocuments.site/reader033/viewer/2022052508/5594c9211a28abcc3c8b45c7/html5/thumbnails/14.jpg)
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
![Page 15: 2C Grundy Extracting Value: Patient Centered Medical Home EHiN 2014](https://reader033.vdocuments.site/reader033/viewer/2022052508/5594c9211a28abcc3c8b45c7/html5/thumbnails/15.jpg)
HIT Infrastructure: EHRs and Connectivity
Primary Care Capacity: Patient Centered Medical Home
Operational Care Coordination: Embedded RN Coordinator and Health Plan Care Coordination $
Value/ Outcome Measurement: Reporting of Quality, Utilization and Patient Satisfaction Measures
Value-Based Purchasing: Reimbursement Tied to Performance on Value (quality, appropriate utilization and patient satisfaction)
Achieve Supportive Base for ACOs and Bundled Payments with Outcome Measurement and Health Plan Involvement
Trajectory to Value Based Purchasing: Achieving Real Care Coordination and Outcome Measurement
Source: Hudson Valley Initiative
![Page 16: 2C Grundy Extracting Value: Patient Centered Medical Home EHiN 2014](https://reader033.vdocuments.site/reader033/viewer/2022052508/5594c9211a28abcc3c8b45c7/html5/thumbnails/16.jpg)
Payment 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”
![Page 17: 2C Grundy Extracting Value: Patient Centered Medical Home EHiN 2014](https://reader033.vdocuments.site/reader033/viewer/2022052508/5594c9211a28abcc3c8b45c7/html5/thumbnails/17.jpg)
Benefit Redesign - Patient Engagement Different Strategies for Different Healthcare Spend Segments
% 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
![Page 18: 2C Grundy Extracting Value: Patient Centered Medical Home EHiN 2014](https://reader033.vdocuments.site/reader033/viewer/2022052508/5594c9211a28abcc3c8b45c7/html5/thumbnails/18.jpg)
Public Health Prevention
Specialists
PCMH 2.0 in Action
Community Care Team
Nurse CoordinatorSocial Workers
DieticiansCommunity Health Workers
Care Coordinators
Public Health PreventionHEALTH WELLNESS
Hospitals
PCMH
PCMH
Health IT Framework
Global Information Framework
Evaluation Framework
Operations
A Coordinated Health System
![Page 19: 2C Grundy Extracting Value: Patient Centered Medical Home EHiN 2014](https://reader033.vdocuments.site/reader033/viewer/2022052508/5594c9211a28abcc3c8b45c7/html5/thumbnails/19.jpg)
Thank you
![Page 20: 2C Grundy Extracting Value: Patient Centered Medical Home EHiN 2014](https://reader033.vdocuments.site/reader033/viewer/2022052508/5594c9211a28abcc3c8b45c7/html5/thumbnails/20.jpg)
![Page 21: 2C Grundy Extracting Value: Patient Centered Medical Home EHiN 2014](https://reader033.vdocuments.site/reader033/viewer/2022052508/5594c9211a28abcc3c8b45c7/html5/thumbnails/21.jpg)
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
A comprehensive approach helps reduce costs while improving care