National Conference on Health and Domestic Violence. Plenary talk

1. Moving Sickcare to Support Violence Prevention Patient Centered Medical Home National Conference on Health Care and Domestic Violence Paul Grundy MD, MPH - IBM Director, Healthcare Transformation @Paul_PCPCC https://twitter.com/Paul_PCPCC

2. The effects of violence on a victim’s health are severe In addition to the immediate injuries: • chronic pain, • gastrointestinal disorders, • psychosomatic symptoms, • eating problems • ACES • It cost lots of $$ and loss productivity • 29% of all women in the United States who attempted suicide were battered.

3. Safeness !!! Safe and secure vs deprived of safety Environment of visibility - seen and be seen vs Isolation Depravation MARY !! Connie Mitchell!! --- SPAIN !!

4. – BUT -where the delivery system works – a Patient in a trusting relation with a healer who is a comprehensivist where the patients data is Used to support We can have the tools to address an issue as difficult as Violence. In much of SICKcare, no one is in charge. And the result is the most Wasteful and Unsustainable

5. 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 Population WITH DATA Community Health Population Health System Integrator Patient Experience Per Capita Cost Public Health @Paul_PCPCC https://twitter.com/Paul_PCPCC

6. 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

7. •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.

8. 17 found improvements in cost 24 improvements in quality 10 found improvements in access 8 found improvements in satisfaction 24 found improvements in utilization

9. USA 2012 Ogden UT

10. MobileFirst Patient Consumer

11. Preventive Medicine Medication Refills Acute Care Nursing Test Results Master Builder DOCTOR Source: Southcentral Foundation, Anchorage AK Behavioral Health Case Manager Medical Assistants Chronic Disease Monitoring Practice transformation away from episode of care

12. 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

13. 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 .

14. 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

15. 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

16. 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”

17. Nearly 1/3 traditional Medicare tied to alternative reimbursement models—such as Patient Centered Medical home (PCMH)/ accountable care organizations (ACOs) or bundled payments—by the end of 2016 50% by end 2018 And end of 2018 90% of traditional Medicare payments to quality or value through programs such as the Partnership for Patients Hospital, Value Based Purchasing and the Hospital Readmissions https://www.youtube.com/watch?v=UY088YyQ6uA

18. 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

19. Public Health Prevention Specialists PCMH 2.0 in Action Community Care Team Nurse Coordinator Social Workers Dieticians Community 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

20. Call & Check Providing support and care for all in the community

21. Thank you

National Conference on Health and Domestic Violence. Plenary talk

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National Conference on Health and Domestic Violence. Plenary talk

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