Models of Primary Care Primary Care – FAMED 530 William R. Phillips, MD, MPH Primary Care – FAMED 530 Department of Family Medicine University of Washington ©2014 WR Phillips

Learning objectives Outline alternative models of primary care: Chronic Care Model Patient-Centered Medical Home Describe the challenges of practice transformation ©2014 WR Phillips

The Triple Aim Improve the patient experience of care Improve the health of populations Reduce the cost of health care. ©2014 WR Phillips

Planned Care Model ©2014 WR Phillips

Patient Centered Medical Home ©2014 WR Phillips

Joint Principles of the PCMH Personal physician Physician directed medical practice Whole person orientation Care is coordinated and/or integrated Quality and safety Enhanced access Payment Reform AAFP, AAP, ACP, AOA ©2014 WR Phillips

Medical Home features Patient-centered Comprehensive Coordinated Accessible Committed to quality and safety ©2014 WR Phillips

Medical Home features Patient-centered: supports patients in learning to manage and organize their own care at the level they choose, and ensures that patients and families are fully informed partners in developing care plans. Comprehensive: a team of care providers is wholly accountable for a patient’s physical and mental health care needs, including prevention and wellness, acute care, and chronic care. Coordinated: ensures that care is organized across all elements of the broader health care system, including specialty care, hospitals, home health care, and community services and supports. Accessible: delivers accessible services with shorter waiting times, enhanced in-person hours, 24/7 electronic or telephone access, and alternative methods of communication through health IT innovations. Committed to quality and safety: demonstrates commitment to quality improvement through the use of health IT and other tools to guide patients and families to make informed decisions about their health. ©2014 WR Phillips

PCMH Patient-centered Comprehensive Coordinated Accessible. Committed to quality and safety What is new? Why does it sell? ©2014 WR Phillips

High Functioning Healthcare Team Shared goals Clear roles of each team member Shared knowledge and skills Effective timely communication Mutual respect Can-do optimistic attitude of team members ©2014 WR Phillips

Transformed Practice Everyone works for the doctor. Traditional Everyone works for the doctor. The “magic” starts when the doctor enters the room with the patient. Transformed Everyone works for the patient. The “magic” starts when the patient enters the office, or even before with pre- planned visits. ©2014 WR Phillips

Practice Transformation Team function Resources Facilitation Adaptive reserve ©2014 WR Phillips

Direct Practice Unlimited access for one low, monthly payment Unhurried appointments with doctors who focus completely on your health and wellbeing Health care support in person, by phone, or email No co-payments, co-insurance, or deductibles No long-term contracts when joining No restrictions based on age or pre-existing conditions—everyone is welcome ©2014 WR Phillips

Polyclinic Model Multiple limited specialists Internal Medicine Pediatrics Obstetrics-Gynecology Access to multiple specialists ©2014 WR Phillips

Hub and Spoke Model Inter-professional team Multiple non-physician clinicians Diagnose and manage common simple problems Triage and refer difficult cases Central physician Manages challenging cases Supervises medical management team ©2014 WR Phillips

Med-Peds Model Combined residency training Classical IM 3 years Classical Peds 3 years Combined Med-Peds 4 years ©2014 WR Phillips

PCMH payment reform Recognizes the added value provided to patients. Reflect the value of care management work that falls outside of the face-to-face visit, by physician and non-physician staff. Pay for services associated with coordination of care within practice and among consultants, ancillary providers, and community resources. Support adoption and use of HIT for quality improvement. Support enhanced communication, such as secure e-mail and telephone consultation. ©2014 WR Phillips

PCMH payment reform Recognize value of work assoc. with remote clinical monitoring. Allow for separate fee-for-service payments. Recognize case mix in the patient population within the practice. Allow sharing of savings from reduced hospitalizations assoc care management. Allow added payments for achieving measurable and continuous quality improvements. ©2014 WR Phillips

Thank You Thanks to the support of Theodore J. Phillips Endowed Professorship in Family Medicine. Department of Family Medicine University of Washington, Seattle, WA ©2014 WR Phillips

Contact Information William R. Phillips, MD, MPH Theodore J. Phillips Endowed Professor in Family Medicine Box 356390, Room E304 University of Washington Seattle, WA 98195-6390 Tel: (206) 543-9425 wphllps@u.washington.edu ©2014 WR Phillips

Patient-Centered Care 1. Explore patient’s disease and illness experience: Feelings about being ill Ideas about what is wrong Impact of the problem on daily functioning Expectations of what should be done 2. Understand the whole person. 3. Reach common ground. 4. Incorporate prevention and health promotion. 5. Enhance the patient-clinician relationship. 6. Be realistic. ©2014 WR Phillips