Alliance for Health Reform Briefing The Patient-Centered Medical Home: Strategy to Improve Health System Performance Melinda Abrams, MS The Commonwealth Fund Alliance for Health Reform Briefing September 22, 2008

Primary Care Score vs. Health Care Expenditures, 1997 UK DK NTH FIN SP CAN AUS SWE JAP GER This slide shows the relationship between strength of primary care systems in different countries and HC expenditures. A high primary care score is a country with a strong PC foundation, such as the UK, which scores the highest. What you notice is the black diamond all the way to the right is the U.S. – greatest per capita expenditure, weakest orientation to primary care. The PCMH is a strategy to strengthening that foundation. US BEL FR Starfield 10/00 00-133 Starfield 10/00 IC 1731

What is a Medical Home? 2020 Vision “A medical home is not a building, house, or hospital, but rather an approach to providing comprehensive primary care . . . A medical home is defined as primary care that is accessible, continuous, comprehensive, family centered, coordinated, compassionate, and culturally effective.” American Academy of Pediatrics 2020 Vision Accessible Patient Centered Coordinated Care organizes care around the relationship between the patient and the personal clinician

The Patient-Centered Medical Home: Principles of Four Primary Care Specialty Societies Personal Physician Whole person orientation Coordinated and integrated care Safe and high-quality care (e.g., evidenced-based medicine, appropriate use of HIT, continuous QI) Enhanced access to care Payment that recognizes the added value provided to patients who have a patient-centered medical home *** A Systems Approach: Access, Quality and Efficiency ACP, AAFP, AAP and AOA. Joint Principals of the Patient-Centered Medical Home, March 2007.

Six Attributes of High Performance Health Care Delivery System Patients' clinical information is available to all providers at the point of care and to patients through electronic systems. Patient care is coordinated among multiple providers, and transitions across care settings are actively managed. Providers (including nurses and other members of care teams) both within and across settings have accountability to each other, review each other's work, and collaborate to reliably deliver high-quality, high-value care. Patients have easy access to appropriate care and information including after hours; there are multiple points of entry to the system; and providers are culturally competent and responsive to patients' needs. There is clear accountability for the total care of patients. The system is continuously innovating and learning in order to improve the quality, value, and patients' experiences of health care delivery.

Organization and Payment Methods Outcome measures; large % of total payment Full Population Prepayment Less Feasible Global Case Rates Care coordination and intermediate outcome measures; moderate % of total payment Continuum of P4P Design Continuum of Payment Bundling More Feasible Medical Home payments Simple process and structure measures; small % of total payment Fee-for-Service Small practices; unrelated hospitals Independent Practice Associations; Physician Hospital Organizations Fully integrated delivery system Continuum of Organization Source: The Commonwealth Fund, 2008

Visit the Fund at: www.commonwealthfund.org Acknowledgements Rachel Nuzum, Senior Policy Director, The Commonwealth Fund Elizabeth Hodgman, Program Associate, Patient-Centered Primary Care Initiative Visit the Fund at: www.commonwealthfund.org