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The Patient-Centered Medical Home Strategy to Improve Health System by wlx15873

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									    THE
COMMONWEALTH
    FUND




  The Patient-Centered Medical Home:
   Strategy to Improve Health System
              Performance

                     Melinda Abrams, MS
                   The Commonwealth Fund

               Alliance for Health Reform Briefing
                      September 22, 2008
              Primary Care Score vs. Health
                 Care Expenditures, 1997

                      2
                                  UK
                                    DK
Primary Care Score




                     1.5                     NTH
                                   FIN
                           SP
                                                   CAN
                      1                AUS

                             SWE
                                         JAP
                     0.5
                                                         GER                             US
                                         BEL       FR
                      0
                      1000       1500        2000        2500   3000        3500         4000
                                Per Capita Health Care Expenditures
                                                                                                         THE
                                                                                                     COMMONWEALTH
                                                                                                         FUND
                                                                 Starfield 10/00   Starfield 10/00
                                                                 00-133            IC 1731
           What is a Medical Home?

• “A medical home is not a
  building, house, or hospital,
  but rather an approach to
  providing comprehensive
  primary care . . . A medical
  home is defined as primary
  care that is accessible,         2020 Vision
  continuous,                        Accessible
                                   Patient Centered
  comprehensive, family
                                  Coordinated Care
  centered, coordinated,
  compassionate, and
  culturally effective.”
      – American Academy of
        Pediatrics
                                                          THE
                                                      COMMONWEALTH
                                                          FUND
      The Patient-Centered Medical Home:
 Principles of Four Primary Care Specialty Societies

  • Personal Physician
  • Whole person orientation
  • Coordinated and integrated care
  • Safe and high-quality care (e.g., evidenced-based
    medicine, appropriate use of HIT, continuous QI)
  • Enhanced access to care
  • Payment that recognizes the added value provided to
    patients who have a patient-centered medical home


  *** A Systems Approach: Access, Quality and Efficiency
                                                                                                 THE
                                                                                             COMMONWEALTH
                                                                                                 FUND

ACP, AAFP, AAP and AOA. Joint Principals of the Patient-Centered Medical Home, March 2007.
     Six Attributes of High Performance
        Health Care Delivery System
1.    Patients' clinical information is available to all providers at the
      point of care and to patients through electronic systems.
2.    Patient care is coordinated among multiple providers, and
      transitions across care settings are actively managed.
3.    Providers (including nurses and other members of care teams)
      both within and across settings have accountability to each other,
      review each other's work, and collaborate to reliably deliver high-
      quality, high-value care.
4.    Patients have easy access to appropriate care and information
      including after hours; there are multiple points of entry to the
      system; and providers are culturally competent and responsive to
      patients' needs.
5.    There is clear accountability for the total care of patients.
6.    The system is continuously innovating and learning in order to
      improve the quality, value, and patients' experiences of health      THE
                                                                       COMMONWEALTH
      care delivery.                                                       FUND
                                 Organization and Payment Methods
Continuum of Payment Bundling


                                                                                                             Outcome




                                                                                                                               Continuum of P4P Design
                                    Full                                                                     measures;
                                Population                                                                large % of total
                                Prepayment                                                                    payment

                                                             Less
                                Global Case                Feasible
                                   Rates                                                                        Care
                                                                                                            coordination
                                                                                                                 and
                                                                                                            intermediate
                                                                                                              outcome
                                                                              More                           measures;
                                                                             Feasible
                                  Medical                                                                  moderate % of
                                   Home                                                                    total payment
                                 payments

                                                                                                          Simple process and
                                                                                                                structure
                                  Fee-for-                                                                 measures; small %
                                  Service                                                                   of total payment
                                              Small practices;    Independent Practice     Fully integrated
                                                unrelated        Associations; Physician   delivery system
                                                hospitals        Hospital Organizations                                   THE


                                                      Continuum of Organization
                                                                                                                      COMMONWEALTH
                                                                                                                          FUND


      Source: The Commonwealth Fund, 2008
   Acknowledgements

    Rachel Nuzum,
    Senior Policy Director,
    The Commonwealth Fund




    Elizabeth Hodgman,
    Program Associate,
    Patient-Centered Primary Care Initiative




       Visit the Fund at:
www.commonwealthfund.org                       THE
                                           COMMONWEALTH
                                               FUND

								
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