1. Primary Care & New Jersey James E. Barr, MD Medical/Executive Director, Central Jersey Physician Network IPA Horizon BCBS of NJ HMO Board Member Member, Patient-Centered Primary Care Collaborative Partner/Owner, Pleasant Run Family Physicians, Flemington, NJ A Level III Patient-Centered Medical Home 1

2. Joint Principles of the PCMH Payment for added value Quality and safety Enhanced access Coordinated care – part 2 Personal physician Coordinated care - part 1 Physician-directed practice Whole-person orientation 2

3. TODAY’S CARE MEDICAL HOME CARE My patients are those who make appointments to see me Our patients are those who are registered in our medical home Patient’s reason for visit determines care We systematically assess all our patients’ health needs to plan care Care is reactive to the patient’s problem and visit time available Care is proactive to meet patient needs with or without visits Care varies by memory or skill of the doctor Care is standardized according to evidence-based guidelines Patients are responsible for coordinating their own care A prepared team of professionals coordinates all patients’ care Slide adapted from Daniel Duffy MD School of Community Medicine Tulsa Oklahoma

4. 4 I know I deliver high quality care because I’m well trained We measure our quality and make rapid changes to improve it It’s up to the patient to tell us what happened to them We track tests & consultations, and follow-up after ED & hospital Clinic operations center on meeting the doctor’s needs A multidisciplinary team works at the top of our licenses to serve patients Acute care is delivered in the next available appointment and walk-ins Acute care is delivered by open access and non-visit contacts TODAY’S CARE MEDICAL HOME CARE Slide adapted from Daniel Duffy MD School of Community Medicine Tulsa Oklahoma

5. NCQA PPC-PCMH Recognition Program: 9 Standards 1.Access and Communication 2.Patient Tracking and Registry Functions 3.Care Management 4.Patient Self-Management Support 5.E-Prescribing 2-6 Elements per Standard 3 Levels of Certification 6.Test Tracking 7.Referral Tracking 8.Performance Reporting and Improvement 9.Advanced Electronic Communications Standards are inclusive of “ Must Pass Elements ” 5

6. Performance & Transparency

7. Pay For Results Pre-Assessment of Practice Readiness Support from ACP, AAFP, AOA, AAP, Blue Plans, Employers, Consumer Advocates Blended Payment Methodology NCQA Criteria for Medical Home Process Redesign HIT Evaluate Levels of Achievement Clinical Process and Outcomes Experience Of Care For services currently recognized through Medicare RBRVS system; or additional services PCMH Compensation Model: supports practice transformation, care coordination, and value FFS Prospective Payment Resource Use Costs of Care

8. PCMH Model Experiences  Geisenger Health Plan: 14% reduction in hospital admissions relative to controls, 9% reduction in overall costs  Group Health Cooperative: 25% reduction in diabetic costs related to specialists and hospital admissions, 11% reduction in overall costs  Johns Hopkins: 15% decrease in ER visits, 24% reduction in hospital inpatient days, annual $1,362 net Medicare savings per patient  North Dakota Blues: Diabetics 4:1 ROI  Community Care North Carolina: $225 million savings  Health Partners: 39% decrease in ER visits, 24% decrease in hospital admissions, 8% reduction in overall costs  Intermountain Healthcare: 10% reduction in hospital admissions, net reduction in total costs $640 per patient per year

9. For More Information o Patient-Centered Primary Care Collaborative – www.pcpcc.net www.pcpcc.net o Bridges to Excellence – Medical Home Recognition Program www.bridgestoexcellence.org www.bridgestoexcellence.org o NCQA Physician Practice Connections Patient-Centered Medical Home www.ncqa.orgwww.ncqa.org o www.medicalhomeinfo.org www.medicalhomeinfo.org o Jim Barr, MD JBarr5@aol.com CJPN Office 908-788-0325 Cell 908-337-3483JBarr5@aol.com o Multicultural Healthcare Communications, Arnold Joseph, 917-887-3405 9