Patient Centric Primary Care Roundtable

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Patient Centric Primary Care Roundtable

• AAFP AAP ACP AOA
• Joint Principles of the Patient-Centered Medical
  Home
• Rosemarie Sweeney MPA
• Vice President, Public Policy and Practice
  Support
• American Academy of Family
  Physicians

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Patient Centric Primary Care Roundtable

• Primary Care
• The provision of first contact,
  person-focused ongoing care over time that meets
  the healthrelated needs of people, referring
  only those too uncommon to maintain competence,
  and coordinates care when people receive service
  services at other levels of care.
• Starfield
  09/04

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Patient Centric Primary Care Roundtable

• Most primary care in the US is provided by
  physicians who have completed residency training
  in family medicine, general internal medicine and
  pediatrics.

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Patient Centric Primary Care Roundtable

• Why is Primary Care Important
• Better health outcomes
• Lower costs
• Greater equity in health
• Starfield 09/04

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Patient Centric Primary Care Roundtable

• Patients who have an ongoing relationship with a
  primary care physician have better outcomes and
  lower costs (1)
• When care is managed effectively in the
  ambulatory setting by primary care physicians,
  patients with chronic diseases like diabetes,
  CHF, and adult asthma have fewer complications,
  leading to fewer avoidable hospitalizations (2)
• Starfield, presentation to Commonwealth Fund
  Roundtable on Primary Care, October 2006
• Commonwealth Fund, Chartbook on Medicare, 2006

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Patient Centric Primary Care Roundtable

• In other words
• A Patient-Centered Medical Home

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Patient Centric Primary Care Roundtable

• What is the patient centered medical home?
• Joint principles from AAFP, AAP, ACP and AOA
  outline the model, attributes, and payment
  structure

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Patient Centric Primary Care Roundtable

• Each patient has an ongoing relationship with a
  personal physician rained to provide provide
  first contact, continuous and comprehensive care

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• The physician directed medical practice works as
  a team of individuals who collectively take
  responsibility for the ongoing care of patients

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Patient Centric Primary Care Roundtable

• Whole person orientation
• The medical home provides for all the
  patients health care needs or takes
  responsibility for arranging care with other
  qualified professionals

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Patient Centric Primary Care Roundtable

• Care for all stages of life
• Acute care
• Chronic care
• Preventive services
• End of life care

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Patient Centric Primary Care Roundtable

• Care is coordinated across health care system
  and community
• Subspecialty care
• Hospitals
• Home health
• Nursing home
• Family
• Community based services

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Patient Centric Primary Care Roundtable

• Care is facilitated by
• -Registries
• -Information Technology
• -Health Information Exchange
• using systems-based approaches to improve care
  coordination and management

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Patient Centric Primary Care Roundtable

• Quality and Safety are Hallmarks of the medical
  home
• - Patient Centered Outcomes
• - Evidence-based medicine
• - Clinical decision support tools

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Patient Centric Primary Care Roundtable

• Physicians engage in continuous quality
  improvement and performance measurement and
  improvement
• Information technology supports optimal patient
  care, performance measurement

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Patient Centric Primary Care Roundtable

• Convenience for patients
• - Open scheduling (same day appointments)
• - Extended hours
• - Email communication, phone
• consults, etc.

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Patient Centric Primary Care Roundtable

• Accountability to patients and payors
• Practices participate in a voluntary
  recognition process to demonstrate they have the
  capabilities to provide services of the patient
  centered medical home

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Patient Centric Primary Care Roundtable

• Assures accountability to the purchaser
  (employer) and the consumer (employee) on
  quality, patient satisfaction and cost of care
  measures

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Patient Centric Primary Care Roundtable

• Payment recognizes the added value provided to
  patients with patient centered medical home

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Patient Centric Primary Care Roundtable

• Care management work that falls outside the
  office visit
• Care coordination within practice and between
  consultants, other providers
• Adoption and use of HIT for quality improvement
• Provision of enhanced communication (email, phone
  consultation)

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Patient Centric Primary Care Roundtable

• Payment Structure
• Fee for service for face to face visits
• Care management fee to recognize added value
• Additional payment for achieving measurable and
  continuous quality improvement

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Patient Centric Primary Care Roundtable

• RESULTS
• Employees will get better care
• Employees will have higher patient satisfaction
• Employees may need to take less time off from
  work
• Employers will have lower costs