1. Consumer-Purchaser Disclosure Project The Patient Centered Medical Home A New Model for Primary and Principal Care Washington, DC October 17, 2007 John Tooker MD,MBA,FACP Chief Executive Officer/EVP American College of Physicians

2. The Patient Centered Medical Home Scope of Presentation Rationale for the model Rationale for the model Description of the model Description of the model Building consensus Building consensus The question we asked : Is there a better way to organize and finance care by primary and principal care physicians that will lead to better outcomes, lower costs, and increased interest in general IM?

3. Patients Awash in Information, Patients Face a Lonely, Uncertain Road August 14, 2005 ( HOFFMAN,J) Sick and Scared, and Waiting, Waiting, Waiting August 20, 2005 (KOLATA) 55 % of adults surveyed said they were dissatisfied with the quality of their health care, up from 44 percent in 2000; and 40 percent said the quality of care had gotten worse in the last five years. Harvard University, AHRQ and the Kaiser Family Foundation (2004) How Many Doctors Does It Take to Treat a Patient? June 27, 2007 (BACH)

4. Informed, Activated Patient Productive Interactions Prepared, Proactive Practice Team Delivery System Design Decision Support Clinical Information Systems Self- Management Support Health System Resources and Policies Community Health Care Organization Wagner Care Model Improved Outcomes

5. Of a Like Mind We found that other primary care groups—AAFP, AAP, and AOA—have policies that support physician-guided, patient-centered care through a “medical home” We found that other primary care groups—AAFP, AAP, and AOA—have policies that support physician-guided, patient-centered care through a “medical home” AAFP, AOA, AAP and ACP joint principles incorporate the thinking of all four organizations into the “patient centered medical home” (PCMH) AAFP, AOA, AAP and ACP joint principles incorporate the thinking of all four organizations into the “patient centered medical home” (PCMH)

6. Joint Principles of the PCMH AAP, AAFP, ACP, AOA March 2007 Whole person orientation Whole person orientation Personal physician Personal physician Physician directed medical practice Physician directed medical practice Care is coordinated and/or integrated Care is coordinated and/or integrated Quality and safety Quality and safety Enhanced access to care Enhanced access to care Payment to support the PC-MH Payment to support the PC-MH

7. Building Consensus AAFP, AAP, ACP, AOA – “Joint Principles” March 2007 AAFP, AAP, ACP, AOA – “Joint Principles” March 2007 NCQA PPC PCMH qualification - July 2007 NCQA PPC PCMH qualification - July 2007 Patient Centered Primary Care Collaborative Principles (PCPCC) May 2007 Patient Centered Primary Care Collaborative Principles (PCPCC) May 2007  ERIC  Consumers  Health plans (September 2007)  Physicians  QI organizations

8. Current Events Proving the concept – demos Proving the concept – demos  Private sector United United PCPCC multi-player (plans and employers) PCPCC multi-player (plans and employers) Medicare demo Medicare demo Medicaid projects Medicaid projects Costing the medical home project Costing the medical home project PCPCC summit – November 7th PCPCC summit – November 7th