explaining how the Patient Centered Medical Home (PCMH) platform for healthcare deliver is more likely to support domestic violence prevention and creat a safer environment than the FFS episode of care system we are in now. The medical Home is a home for the data where the all the data goes and is held accountable this idea was first articulated by Dr. Calvin C.J. Sia, a Honolulu-based pediatrician in 1967.
This concept of the medical home was integrated with Ed Wagners Chronic disease Model and Thomas Bodenheimer Kevin Grumbach advanced/proactive primary care at the request of the Patient Centered Primary care Collaborative into a set of principles Know as the Joint principles of the Patient centered medical home.
The patient-centered medical home (PCMH), is a team based health care delivery set of principles led by a physician that provides comprehensive and continuous medical care to patients with the goal of obtaining maximized health outcomes. It is "an approach to providing comprehensive primary care for children, youth and adults" The provision PCMH medical homes allow better access to health care, increase satisfaction with care, and improve health. Joint principles that define a PCMH have been established through the cohesive efforts of the American Academy of Pediatrics (AAP), American Academy of Family Physicians (AAFP), American College of Physicians (ACP), and American Osteopathic Association (AOA).[10] Care coordination is an essential component of the PCMH. Care coordination requires additional resources such as health information technology, and appropriately trained staff to provide coordinated care through team-based models. Additionally, payment models that compensate PCMHs for their effort devoted to care coordination activities and patient-centered care management that fall outside the face-to-face patient encounter may help encourage coordination.
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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.
4. Safeness !!!
Safe and secure vs deprived of safety
Environment of visibility - seen and be seen vs Isolation Depravation
MARY !!
Connie Mitchell!! --- SPAIN !!
5. – 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
6.
7. 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
8.
9. 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
10. •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.
11. 17 found
improvements in
cost
24 improvements in
quality
10 found
improvements in
access
8 found
improvements in
satisfaction
24 found
improvements in
utilization
15. 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
16. 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
17. 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
.
18. 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
19. 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
20. 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”
21.
22. 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
23. 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
24. 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
25. Call & Check Providing support
and care for all in the community