1. 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

2. 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, Institute of Medicine, National Academy Press
Accessed at:

3. 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

4. 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?

5. 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

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

7. “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

8. 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

9. 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

10. 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

11. 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

12. 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

13. Patient Team
Health 2.0
Practice Team
The New PCMH Team?

14. 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”

15. 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

16. 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