1. Tad P. Fisher Executive Vice President Florida Academy of Family Physicians Patient Centered Medical Home A Medicaid Managed Care Alternative

2. The healthcare world is changing in ways that many of us have never seen in our lifetime, with the possible exception of Medicare.

3. “It is not the strongest of the species that survives, nor the most intelligent, but the one most responsive to change.” Charles Darwin

4.  There will be winners and losers at all levels as a result of healthcare (health insurance) reform.

5. Source: The Advisory Board, 2010 2013 Pilots*2012 Pilots* *Medicare Pilots – waiver of anti-trust & anti-kickback Today Pilots Today Source: Advisory Board

6. Physicians & Staff  Happier staff  Happier physicians  Increased net revenue  Increased take-home pay in today’s environment  Team-based care  Decreased panel size?  Relatively rapid returns from transformation  Increased standardization of care Patients  Improved satisfaction  Improved preventive care  Improved quality measures  Reduced ED utilization  Reduced readmissions  Reduced hospitalizations  Longer team-based appointments; enhanced communication  Reduced per capita cost for certain chronic conditions

7.  Team-based care  Focus on the top of license/training & interest  Improved communication  Improved data flow & access  Right patient at the right time  Patient-centered aligned incentives – outcomes, quality, cost  External accountability – outcomes, quality, cost

8.  Personal Physician trained to provide continuous, comprehensive care  Physician-Directed Medical Practice  Whole Person Orientation  Coordinated Care  Quality and Safety  Enhanced Access to Care  Payment appropriately recognizes added value provided to the overall system

9.  The Patient Centered Medical Home creates a framework for change  The Patient Centered Medical Home creates a common language for change  The Patient Centered Medical Home creates an opportunity for change

10. Access to Care & Information Health care for all Same-day appointments After-hours access coverage Accessible patient and lab information Online patient services Electronic visits Group visits Practice Management Disciplined financial management Cost-Benefit decision-making Revenue enhancement Optimized coding & billing Personnel/HR management Facilities management Optimized office design/redesign Change management Practice-Based Services Comprehensive care for both acute and chronic conditions Prevention screening and services Surgical procedures Ancillary therapeutic & support services Ancillary diagnostic services Care Management Population management Wellness promotion Disease prevention Chronic disease management Patient engagement and education Leverages automated technologies Care Coordination Community-based services Collaborative relationships Emergency room Hospital care Behavioral health care Maternity care Specialist care Pharmacy Physical Therapy Case Management Care transition Practice-Based Care Team Provider leadership Shared mission and vision Effective communication Task designation by skill set Nurse Practitioner / Physician Assistant Patient participation Family involvement options Quality and Safety Evidence-based best practices Medication management Patient satisfaction feedback Clinical outcomes analysis Quality improvement Risk management Regulatory compliance Health Information Technology Electronic medical record Electronic orders and reporting Electronic prescribing Evidence-based decision support Population management registry Practice Web site Patient portal

11. Access to Care and information Practice Level Services Care Management Continuity of Care Services Practice Based Team Care Quality and Safety Health Information Technology Practice Management Patients

12. 1. Trust 2. Ability to constructively manage conflict 3. Commitment to both one’s own job and the larger mission 4. Ownership and accountability – everyone is a leader in their own area. 5. Follow-through

13. Collaborative Care Coordinated Care Shared Responsibilities Community Resources Team Care in and outside the practice Interoperable Technology Shared vision/alignment Education

14. Improved Outcomes! a. Quality b. Chronic Disease c. Transitions in care d. Satisfaction e. Efficiency (cost savings) f. Practice Financials

15. Primary Care Practice Management Health IT Patient Service Quality Built In Great Outcomes Continuous Healing Relationship Whole Person Orientation Family and Community Context Comprehensive Care Financial Personnel Clinical Systems Culture of Improvement Performance Measurement Reliable Systems Convenient Access Personalized Care Care Coordination Patients Office Staff Physicians Community Process Automation (EHR) Communication Connectivity EBM Support Clinical Information Systems