1. Introduction to Healthcare and Public Health in the US The Evolution and Reform of Healthcare in the US Lecture d This material (Comp1_Unit9d) was developed by Oregon Health & Science University, funded by the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology under Award Number IU24OC000015.

2. The Evolution and Reform of Healthcare in the US Learning Objectives 2 Describe evidence-based medicine, clinical practice guidelines, and quality indicators in medicine (Lecture a, b, c) Describe the patient-centered medical home model (Lecture d) Discuss the key issues driving healthcare reform in the US (Lecture e) Health IT Workforce Curriculum Version 3.0/Spring 2012 Introduction to Healthcare and Public Health in the US The Evolution and Reform of Healthcare in the US Lecture d

3. History of The Medical Home Concept 3 Health IT Workforce Curriculum Version 3.0/Spring 2012 Introduction to Healthcare and Public Health in the US The Evolution and Reform of Healthcare in the US Lecture d 1967 -- The American Academy of Pediatrics (AAP) introduced the medical home concept 2002 -- the AAP expanded the medical home concept to include specific characteristics of patient care: –Accessible –Continuous –Comprehensive –Family-centered –Coordinated –Compassionate –Culturally effective

4. History of The Medical Home Concept (continued) The American Academy of Family Physicians (AAFP) and the American College of Physicians (ACP) have developed their own models for improving patient care –2004 – AAFP “medical home” –2006 – ACP “advanced medical home” 4 Health IT Workforce Curriculum Version 3.0/Spring 2012 Introduction to Healthcare and Public Health in the US The Evolution and Reform of Healthcare in the US Lecture d

5. The Patient-Centered Medical Home (PCMH) 5 Health IT Workforce Curriculum Version 3.0/Spring 2012 Introduction to Healthcare and Public Health in the US The Evolution and Reform of Healthcare in the US Lecture d 2007 -- Joint Principles of the patient-centered Medical Home delineated by: –American Academy of Family Physicians (AAFP) –American Academy of Pediatrics (AAP) –American College of Physicians (ACP) –American Osteopathic Association (AOA) The PCMH is an approach to providing comprehensive primary care The PCMH is a healthcare setting that facilitates partnerships

6. PCMH Characteristics: Personal Physician, Directed Medical Practice 6 Health IT Workforce Curriculum Version 3.0/Spring 2012 Introduction to Healthcare and Public Health in the US The Evolution and Reform of Healthcare in the US Lecture d Personal physician - each patient has an ongoing relationship with a personal physician Physician directed medical practice – the personal physician leads a team of individuals at the practice level –The team takes collective responsibility for patient care

7. PCMH Characteristics: Whole Person Orientation 7 Health IT Workforce Curriculum Version 3.0/Spring 2012 Introduction to Healthcare and Public Health in the US The Evolution and Reform of Healthcare in the US Lecture d Whole person orientation – the personal physician is responsible for providing for all the patient’s healthcare needs Care is provided in all stages of life Preventive services are emphasized Care is provided in multiple settings –Acute care –Chronic care –End of life care Preventive services are emphasized

8. PCMH Characteristics: Coordination Of Care 8 Health IT Workforce Curriculum Version 3.0/Spring 2012 Introduction to Healthcare and Public Health in the US The Evolution and Reform of Healthcare in the US Lecture d Care is coordinated and/or integrated across all elements of the healthcare system and the patient’s community Care is facilitated by technology Clinicians provide care that is culturally and linguistically appropriate

9. PCMH Characteristics: Quality And Safety 9 Health IT Workforce Curriculum Version 3.0/Spring 2012 Introduction to Healthcare and Public Health in the US The Evolution and Reform of Healthcare in the US Lecture d Quality and safety measures: Patients are encouraged to achieve patient-centered outcomes Clinicians use evidence based medicine and clinical decision support tools to guide their decision making

10. PCMH Characteristics: Quality And Safety (continued) 10 Health IT Workforce Curriculum Version 3.0/Spring 2012 Introduction to Healthcare and Public Health in the US The Evolution and Reform of Healthcare in the US Lecture d Other quality and safety measures: PCMH model uses information technology to support patient care Practices agree to undergo voluntary recognition process

11. PCMH Characteristics: Quality And Safety (continued) 11 Health IT Workforce Curriculum Version 3.0/Spring 2012 Introduction to Healthcare and Public Health in the US The Evolution and Reform of Healthcare in the US Lecture d Other quality and safety measures: Physicians participate in continuous quality improvement and performance measurement Patients participate in decision-making Patients and families participate in quality improvement activities

12. PCMH Characteristics: Enhanced Access To Care 12 Health IT Workforce Curriculum Version 3.0/Spring 2012 Introduction to Healthcare and Public Health in the US The Evolution and Reform of Healthcare in the US Lecture d Enhanced access to care facilitated by: –Open-access scheduling –Expanded hours –New options for communication Secure messaging and email Use of personal health records

13. PCMH Characteristics: Payment 13 Health IT Workforce Curriculum Version 3.0/Spring 2012 Introduction to Healthcare and Public Health in the US The Evolution and Reform of Healthcare in the US Lecture d Payment appropriately recognizes the added value of a patient-centered medical home Reflects the value of patient-centered care management work Pays for face-to-face visits as well as services associated with coordination of care

14. PCMH Characteristics: Payment (continued) 14 Health IT Workforce Curriculum Version 3.0/Spring 2012 Introduction to Healthcare and Public Health in the US The Evolution and Reform of Healthcare in the US Lecture d Additionally, the PCMH payment model: –Recognizes case mix differences in the practice patient population –Allows for additional payments when quality improvements are achieved –Covers enhanced patient communication access to clinicians –Supports adoption and use of health information technology

15. The Evolution and Reform of Healthcare in the US Summary – Lecture d 15 Described characteristics of the Patient-Centered Medical Home (PCMH) including: –Personal physician –Team approach to care –Whole person, integrated approach –Quality and safety measures –Enhanced Access –Payment Health IT Workforce Curriculum Version 3.0/Spring 2012 Introduction to Healthcare and Public Health in the US The Evolution and Reform of Healthcare in the US Lecture d

16. The Evolution and Reform of Healthcare in the US References – Lecture d References American Academy of Pediatrics, Medical Home Initiatives for Children with Special Needs Project Advisory Committee (2002). The medical home. Pediatrics, 110, 184-186. Joint Principles of the Patient Centered Medical Home. (2007). Retrieved December 6, 2011, from Patient-centered Primary Care Collaborative - American Academy of Family Physicians (AAFP); American Academy of Pediatrics (AAP); American College of Physicians (ACP); American Osteopathic Association (AOA) website: http://www.pcpcc.net/node/14.http://www.pcpcc.net/node/14 Pediatric Records and a "Medical Home". (1967). In Standards of Child Care (pp. 77-79). Evanston, IL: American Academy of Pediatrics. Physician Practice Connections®─Patient-Centered Medical Home (PPC-PCMH™) Recognition Program. Attestation/Agreement. (2007, December). Retrieved December 6, 2011, from The National Committee fro Quality Assurance website: http://www.coloradoafp.org/pdf/PPC- PCMH_Attestation.pdfhttp://www.coloradoafp.org/pdf/PPC- PCMH_Attestation.pdf 16 Health IT Workforce Curriculum Version 3.0/Spring 2012 Introduction to Healthcare and Public Health in the US The Evolution and Reform of Healthcare in the US Lecture d