lawrence mm june 2011
DESCRIPTION
Lawrence Medical ManagersTRANSCRIPT
6/8/2011
1
Patient Centered Medical Home
What Does it Mean?
Lawrence Medical Managers meeting June 2011
Sheila Richmeier, MS, RN, FACMPE
Declining value of primary care
Primary care is in trouble. . . .
• Overwhelming amount of work
• Poor compensation
• Pipeline is drying up
• Aging and sicker population
• Health care costs skyrocketing
• Quality and coordination lag
• Physician frustration
2010 TransforMED
6/8/2011
2
Aging and sicker population
•52% of the American population has a chronic medical
condition
•Number of older people is projected to rise from 31.6 to 65
million from 1990 to 2030
•Lifestyles are having an impact on health like never before
•2/3 of elderly are overweight or obese
•Obesity rates have doubled
• since mid-80s alone
AHRQ Chronic Care
• 52% of US population has a chronic disease
• Individuals with chronic illness account for 80% of health care spending
▫ 75% of every dollar
▫ 83% of every Medicaid dollar
▫ 99% of every Medicare dollar
• Life style is having an impact on health
▫ 2/3 of elderly are overweight or obese
▫ Obesity rates have doubled since mid-80s
▫ Obesity is responsible for 1/3 of the growth of health care spending
Hitting the “Bulls-eye” in Health Reform
Rising costs
2010 TransforMED
• Increasing Prevalence of Chronic Conditions and Increasing Costs
118
125
133
141
149
157
80
90
100
110
120
130
140
150
160
170
180
1995 2000 2005 2010 2015 2020
40%
41%
42%
43%
44%
45%
46%
47%
48%
49%Chronic Condition Prevalence Annual Cost
Cardiovascular Disease 80 million $475.3 billion (includes both direct and indirect costs)
Diabetes 23.6 million $116 billion of direct healthcare costs
$58 billion in indirect costs/ lost productivity
Asthma ~20 million $18.3 billion, including direct healthcare costs (10.1 billion) and indirect costs/ lost productivity (8.2 billion)
Depression 20.9 million ~$100 billion of direct healthcare costs (across all mental illnesses)
~$79 billion in indirect costs/ lost productivity (across all mental illnesses)
Cost of Specific Chronic ConditionsPrevalence of Chronic Conditions
6/8/2011
3
Frustration
Value of primary care
• Easily accessible first contact with the health care system
• Comprehensive care for all health related situations regardless of age or sex
• Coordination and integration of care across
settings
• Personal relationships over time through partnerships in the context of family and community
Easily accessible
• Time▫ Office hours
▫ Same day access
• Location
• Delivery▫ In person
▫ On phone
▫ Interactive websites
• Availability ▫ Language barriers
▫ Transportation problems
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6/8/2011
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Timely access
73% of Americans report having difficulty in obtaining timely access to their doctor
Source: Commonwealth Fund Survey of Public Views of the U.S. Health Care System, 2008.
60
41
30
73
0 25 50 75 100
Percent reporting that it is very difficult/difficult:
2010 TransforMED
11
11
After hours care without ER visit
* Base: Needed care and answered question.
5965 63
57
3338
45
68
4338
63
0
25
50
75
100
AUS CAN FR GER NETH NZ NOR SWE SWIZ UK US
Percent reported very/somewhat difficult getting care on nights,
weekends, or holidays without going to ER*
Source: 2010 Commonwealth Fund International Health Policy Survey in Eleven Countries.
2010 TransforMED
12
33
44
2722
2629
26
35
2225
37
0
25
50
75
AU
S
CA
N
FR
GE
R
NE
TH
NZ
NO
R
SW
E
SW
IZ UK
US
Emergency Room Use in Past Two Years
Percent
1016
5 510 8 7
129 7
15
AU
S
CA
N
FR
GE
R
NE
TH
NZ
NO
R
SW
E
SW
IZ UK
US
Any ER use Used ER for condition treatable
by regular doctor, if available
Source: 2010 Commonwealth Fund International Health Policy Survey in Eleven Countries.
6/8/2011
5
0
200
400
600
800
1000
2005 2006 2007
Growth of Retail Clinics, Year End 2005–2007
60
18 states
Source: Interview with Mary Kate Scott, principal of Scott & Company, July 2008.
Number of retail clinics
800
23 states
900
30 states
Dec. 07
Dec. 06
Dec. 05
Retail clinic choices64 62
5348
34
0
20
40
60
80
Notes: Categories are not mutually exclusive; respondents were able to select multiple categories.
Source: Center for Studying Health System Change 2007 Health Tracking Household Survey, April 2007–January 2008.
Clinic hours
were more
convenient
than another
source of care
Did not have
to make an
appointment
for a
retail clinic
Cost was
lower than
another
source of care
Did not have
a usual
source of care
Location
was more
convenient
than another
source of care
%
Traditional Model New Model
• Unnecessary barriers to access
by patient
• Monday through Friday
9 – 5
• In person visit only
• Primary care physician could
not see you
• Same or next day access by
patients
• After hours and weekend care
• Alternate means of
communication
▫ Interactive website
▫ Phone triage and follow-up
• Same physician or team sees you
every time
• Alternate visit types
▫ Group visits
▫ e-visits
6/8/2011
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Comprehensive
• Whole person care
• Population management▫ Preventive
▫ Chronic disease management
• Non-differentiated care
• Often birth to death
• Evidence based
• Quality versus quantity
16
Traditional Model New Model
• Event – based medicine
• Experience based
▫ Docs with the most
experience are the best
docs
• Continuous healthcare
• Quality improvement
▫ Patient experience survey
▫ Provider satisfaction survey
▫ Employee satisfaction survey
▫ Clinical outcome
measurement
▫ Financial outcome
measurement
▫ Study and planning of results
• Evidence based▫ Evidence based guidelines
▫ Clinical outcomes reported
Traditional Model New Model
• Reactive management of
patients’ preventive and
chronic care
▫ Patient makes appointment
when needed
▫ Acute chronic is managed in
hospital setting
▫ High acuity patients are
known as “frequent flyers”
• Pro-active population
management for chronic and
preventive care
▫ Anticipate needs of patients
prior to visit
▫ Pre-visit planning
▫ Management of high acuity
patients more intensely
▫ Overall better management
of chronics
6/8/2011
7
Coordination of care
• Emphasis on communication▫ With patient /family
▫ Across settings
• Facilitate transitions▫ Information
▫ Accountability
• Community resources▫ Home health
▫ Nursing homes
▫ Health departments
• Tracking & follow-up▫ Referral tracking
▫ Test tracking
• Medical neighborhood
19
2010 TransforMED
Medicare re-hospitalization rates
JAMA
6/8/2011
8
Traditional Model New Model
• Reactive coordination of care
• Referral specialists taking
over care
• Patient goes to specialists as
needed
• Proactive transitions of care
between hospitals and primary
care
▫ Patients are pro-actively
called after hospitalization
• Agreement on roles &
responsibilities between
specialists and primary care
• Referral and test tracking
• PCP coordinates all care
outside office
Relationship
• Personal physician
• Team assigned to care
• Long term
• Communication▫ For patient
engagement
▫ For patient education
• Continuity
▫ Increased efficiency
▫ Better quality
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Traditional Model New Model
• Physician is the main
source for care• Multidisciplinary team is
the source of care
▫ Each member
participates in the care
▫ Each member has a
role
▫ All members
understand each
others’ roles
Traditional Model New Model
• Communication as
needed with patients –
sharing only need to
know information
• Directive communication
• Patient engagement
▫ Giving test result
numbers
▫ Giving patients
information resources
▫ Knowledge by patient
about internal and
external team members
• Collaboration
▫ Patients receive care
plan at each visit
▫ Patient is part of care
team helping to make
decisions about care
2010 TransforMED
Goals in running a medical home --
• Good quality outcomes
• Good financial outcomes
• Good satisfaction outcomes
6/8/2011
10
2010 TransforMED
Satisfaction outcomes
• Happy docs
• Happy staff
• Happy patients
Medical home concepts - Access, patient centered care,
team based care
Financial outcomes
Internal Health care system
• Salaries
• Revenues
• Profit margin
• Bonuses
• Cost of unit of service
• Hospitalization
• Re-hospitalizations
• Use of generic drugs
• Complications in
surgery
• ER utilization
Medical home concepts - Care coordination, access,
sound practice management, health information
technology
Quality outcomes
Chronic disease
management
Population
management• Disease specific
▫ Diabetes
▫ Hypertension
▫ Coronary heart
disease
• High users of the system
• Preventive medicine
▫ Cancer screening
▫ Immunizations
• High risk behaviors
▫ Obesity
▫ Smoking
▫ Child safety
Medical home concepts - Care management,
health information technology, care coordination
6/8/2011
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What comes first?
32
2010 TransforMED
Where is medical home?
• PCMH demonstrations rollout in every state except Alaska.
• Medicare Advanced Primary Care demonstration.
• Federal departments and agencies establish PCMH as the foundation for national transformations:
▫ Department of Defense
▫ Department of Veterans’ Affairs
▫ HRSA
6/8/2011
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2010 TransforMED
2010 TransforMED
Get started. . . .
"In order to succeed, your desire for success should be greater than your fear of failure.“ --
Bill Cosby
"The problem in my life and other people's lives is not the absence of knowing what to do, but the absence of doing it.” -- Peter Drucker
Questions
Sheila Richmeier, MS, RN, FACMPE
Remedy Healthcare Consulting
www.RemedyHealthcareConsulting.com