The Patient-Centered Medical Home & Health 2.0 AHRQ Annual Conference September 15, 2009 Michael S. Barr, MD, MBA, FACP Vice President, Practice Advocacy & Improvement Division of Governmental Affairs & Public Policy 202-261-4531 mbarr@acponline.org

IOM Definition of Patient-Centered Care Healthcare that establishes a partnership among practitioners, patients, and their families (when appropriate) to ensure that decisions respect patients’ wants, needs, and preferences and that patients have the education and support they need to make decisions and participate in their own care. Envisioning the National Healthcare Quality Report, 2001. Institute of Medicine, National Academy Press Accessed at: http://books.nap.edu/openbook.php?record_id=10073&page=41

Health 2.0 Definition “The use of social software and its ability to promote collaboration between patients, their caregivers, medical professionals, and other stakeholders in health. Sarasohn-Kahn, J: The Wisdom of Patients: Health Care Meets Online Social Mediia, CHCF April 2009

What is Patient-Centered Care? One of IOM’s six domains of quality Picker Institute – 8 dimensions of care “Nothing about me without me” The right care in the right way at the right time Providing the care that the patient needs in the manner the patient desires at the time the patient desires Shaller, D. Patient-Centered Care: What Does It Take? http://www.pickerinstitute.org/documents/PI%20Shaller%20Final%20Report.pdf

What is the Patient-Centered Medical Home? …a vision of health care as it should be …a framework for organizing systems of care at both the micro (practice) and macro (society) level …a model to test, improve, and validate …part of the health care reform agenda

PCMH Team-based care Links to Comm. HIT Self-Mgt Evidence Quality Cost Access Satisfaction HIT Self-Mgt Evidence System Design

“PCMH” is a Term… …to describe a pathway to excellent health care …to re-claim a role as advocates for our patients (with our patients & their families) …to encourage team-based care …to create educational opportunities …to attract medical students and residents to primary care

The Joint Principles of the PCMH Team-based care: Patient/Family NP/PA RN/LPN Medical Assistant Office Staff Care Coordinator Nutritionist/Educator Pharmacist Behavioral Health Case Manager Social Worker Community resources DM companies Others… Personal physician Physician directed medical practice Whole person orientation Care is coordinated and/or integrated Quality and safety Enhanced access to care Payment to support the PCMH

Patient-Centered, Physician-Guided Care Integrated Community Delivery System or Virtual Team Practice Family Team Physician Patient Adapted from: Defining Primary Care: An Interim Report, Institute of Medicine 1994

Core of Team-Based Care NP/PA RN/LPN Medical Assistant Office Staff Care Coordinator Nutritionist/Educator Pharmacist Behavioral Health Case Manager Social Worker Community resources DM companies Others… Caregivers Immediate family Extended family Friends Neighbors Practice Family Team Physician Patient Adapted from: Defining Primary Care: An Interim Report, Institute of Medicine 1994

Health 2.0 – Who is Using the Internet? 74% of Americans go online 61% of adults look online for health information For health/medical issues: 86% of all adults ask a health professional 68% of all adults ask a friend or family member 57% of all adults use the internet 54% use books or other printed reference material Source: Pew Internet & American Life Project http://www.pewinterent.org/reports/2009/8-The-Social-Life-of-Health-Information.aspx

Health 2.0 – Impact on Decisions/Actions Of the 60% who use online health information (e-patients): 60% say the information affected a decision about how to treat an illness or condition 53% say it led them to ask their physician new questions or to get a second opinion 49% say it changed the way they think about diet, exercise, or stress management 60% say they or someone they know has been helped Source: Pew Internet & American Life Project http://www.pewinterent.org/reports/2009/8-The-Social-Life-of-Health-Information.aspx

Patient Team Health 2.0 Practice Team The New PCMH Team?

Practice Implications Challenges of transformation Initial capital and restructuring costs Ongoing support & maintenance Reporting on quality, cost and satisfaction Implementation of HIT coincident with PCMH Cultural change Information overload Shift/sharing of “power”

Strengths Weaknesses Opportunities Threats Patient-centered model Emphasizes use of evidence-based medicine Reason to expect that it will improve quality & bend the curve on costs Payment models decrease incentive for volume and encourage investment in practice changes to promote quality Requires considerable change in practice Data pending on practicality Unknown return on investment May disenfranchise small practices Workforce projections for primary care Opportunities Threats Demonstration projects including public & private payers Collaboration with other professions and across specialties Health information technology Modeling of different payment models and organizational structures Perception that this is a zero-$um game Depends on primary care workforce Consumers may not understand/accept the model (or name) Unintended consequences

A Commitment to Excellence Patient-centered communication Shared decision making Timely access to care Transparency & accountability Electronic health records Use of comparative effectiveness research & evidence-based guidelines Safety Measure, improve, measure