1. Patient Centered Medical Home and The Medical Neighborhood Daniel Maher, MD, MPH, FACP CAPT, MC, USN Director of Medical Services Naval Medical Center San Diego 6 October 2011

2. Disclaimer: The views expressed in this article are those of the author and do not necessarily reflect the official policy or position of the Department of the Navy, Department of Defense, or the United States Government

3. Objectives Describe the ‘big picture’ Identify the #1 goal of the Medical Home Port Recognize what policymakers are saying about Medical Homes Explore ideas for linking Medical Homes with the Medical Neighborhood

10. Medical Motel 6 To Home Sweet Medical Home To The Medical Mansion

11. Step Back and Remember A simple concept: “Encourage patients to become active participants in their own health, work with them to keep them well and out of the hospital and emergency room, and guide them through the system when they need care.” (Healthcare Executive, Mar/Apr 2011, p27)

12. The View from the top http://www.youtube.com/watch?v=-yGS7jxgyVk http://www.youtube.com/watch?v=tlJBZQZJe-w&feature=related http://www.youtube.com/watch?v=g3eNW_CmG1o http://www.bethesda.med.navy.mil/MedicalHome/MHVideo.aspx http://www.navy.mil/swf/mmu/mmplyr.asp?id=16037 http://www.emmisolutions.com/medicalhome/acp/english.html

16. The Metrics ED utilization Hospitalization rates Specialty care utilization PCM and Team Continuity Same Day access to care Patient satisfaction Staff satisfaction COST aka PMPM

17. PMPM Per member per month = the cost of providing care for your enrolled panel of patients Cost of care directly related to utilization (ED, Hospitalization, Specialty) Bottom line – decrease the cost of care while improving the quality of care

18. The Med Home Team TRUST - “Trust no one, verify everything” - “Show me the data” - “I’ll do it myself” - “It’s faster if I handle it all myself”

19. Building Trust - Are you still asking about, ordering, documenting health maintenance services? - Does your MA or Corpsman copy forward the PMH and Med list for you? - Do you know all the support staff on your team by name? - Do you meet with your team on some regular basis to discuss the health issues of your enrolled panel of patients? - Does your team have a physician leader who actually leads the team in improving the care of your enrolled panel?

20. The Medical Mansion

21. A simple vision: “Encourage patients to become active participants in their own health, work with them to keep them well and out of the hospital and emergency room, and guide them through the system when they need care.” (Healthcare Executive, Mar/Apr 2011, p27)

22. The Medical Neighborhood

25. In Conclusion The Medical Home is complex – perhaps overwhelming Step back and focus on a simple concept of the Medical Home The Medical Home is marketed as the answer to the rising cost of care For Navy Medicine the PMPM is cost of care Link the Medical Home with your local Medical Neighborhood

26. QUESTIONS