1. The Ideal Medical Practices Project The emerging role of the physician Michigan Purchasers Health Alliance September 20, 2007 L. Gordon Moore MD Clinical Associate Professor University of Rochester Departments of Family Medicine and Community and Preventive Medicine Institute for Healthcare Improvement IdealMedicalPractices.org Funded by The Commonwealth Fund and the Physician’s Foundation for Health Systems Excellence

2. Health Insurance Premiums General Inflation Health Care Inflation Health Care continues to grow far in excess of CPI

3. Primary Care Score: 2 = Stronger From Barbara Starfield, MD US UK SP Entrenched Patterns

4. Institute of Medicine: Crossing the Quality Chasm The problems come from poor systems … not bad people “In its current form, habits, and environment, American health care is incapable of providing the public with the quality health care it expects and deserves.” National Academy Press 2001

5. The perfect storm Cost of practice is rising Administrative burden is growing Pipeline of primary care supply is drying up Aging and burned out primary care work force

6. Employer based primary care –Docs have more time with patients Best practice guidelines/protocols Emphasis on health and wellness, prevention Disease management for any with chronic conditions –Improved access with worksite facilities –Refer to “high performance network of specialists” –Integrated EAP/chemical dependency Zastrow RJ, Quadracci L. Engaging Quad/Graphics Employees in the Improvement of Their Health and Healthcare Journal of Ambulatory Care Management, 29(3), 227-231

7. Quad-med results Health care cost increases limited to 6.8% during the last five years With Quad-Med, Quad/Graphics spends 17-20% less than Midwest average Superb HEDIS and employee satisfaction scores PAGE ONE February 11, 2005 Radical Surgery One Cure for High Health Costs: In-House Clinics at Companies By VANESSA FUHRMANS Staff Reporter of THE WALL STREET JOURNAL

8. Good Collaborative Care is A Good Thing Wasson, Johnson, et al. JACM Vol. 29, No. 3, pp. 199–206

10. Getting Focus Catching Your Breath Baseline Surveys ListServe Time Management Access and Efficiency Overhead Baseline Surveys Listserve Time Management Practice Flow Collaborative Care Coaching Vital Signs Electronics Patient Segmentation Self-Management Confidence Problem-Solving Phone Coaching Confidence Working with Others Refinements of Previous Techniques Referrals/Handoffs Execution: The IMP Method

11. A wealth of actionable data

12. A Family of (Free) Patient/Employee/Person Assessment and Feedback Tools that: –Determine “What Matters” –Determine “What is the Matter” –Determine Preventive Needs –Determine Care Experience –Feedback Personalized Information that Supports Additional Actions A Family of Reporting Tools for Practices and Hospitals that: –Automatically Summarize and Compare Responses –Offer Customization Options

15. Key lessons from IMP Significant improvement doesn’t have to come at the cost of heavy lifting Simple HIT drives measurement and improvement Data becomes a platform for adoption of best practices

16. www.IdealMedicalHome.org

17. National collaborative

18. What we’re finding - positive Improved population health Improved experience of care Improvement is within reach of the participants

19. What we are struggling with We’re paid for unit production so we overproduce units (visits, procedures) to maintain revenue streams A lot of the work to improve population health is uncompensated It’s easy to be mislead by the promises of IT

20. Moving ahead Prospective payment models Shared savings arrangements Overcoming inertia of status quo