The Patient-Centered Medical Home and Health 2.0 (Text Version)

On September 15, 2009, Michael S. Barr made this presentation at the 2009 Annual Conference. Select to access the PowerPoint® presentation (1.5 MB). 

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Slide 1

The Patient-Centered Medical Home and Health 2.0

AHRQ Annual Conference
September 15, 2009

Michael S. Barr, MD, MBA, FACP
Vice President, Practice Advocacy & Improvement
Division of Governmental Affairs & Public Policy
202-261-4531
mbarr@acponline.org

Slide 2

IOM Definition of Patient-Centered Care

Healthcare that establishes a partnership among practitioners, patients, and their families (when appropriate) to ensure that decisions respect patients' wants, needs, and preferences and that patients have the education and support they need to make decisions and participate in their own care.

Envisioning the National Healthcare Quality Report, 2001. Institute of Medicine, National Academy Press
Accessed at: http://books.nap.edu/openbook.php?record_id=10073&page=41

Slide 3

Health 2.0 Definition

"The use of social software and its ability to promote collaboration between patients, their caregivers, medical professionals,
and other stakeholders in health."

Sarasohn-Kahn, J: The Wisdom of Patients: Health Care Meets Online Social Mediia, CHCF April 2009

Slide 4

What is Patient-Centered Care?

• One of IOM's six domains of quality
• Picker Institute - 8 dimensions of care
• "Nothing about me without me"
• The right care in the right way at the right time
• Providing the care that the patient needs in the manner the patient desires at the time the patient desires

Shaller, D. Patient-Centered Care: What Does It Take?
http://www.pickerinstitute.org/documents/PI%20Shaller%20Final%20Report.pdf 

Slide 5

What is the Patient-Centered Medical Home?

• ...a vision of health care as it should be
• ...a framework for organizing systems of care at both the micro (practice) and macro (society) level
• ...a model to test, improve, and validate
• ...part of the health care reform agenda

Slide 6

Image: The PCMH is surrounded by the four key factors necessary for any restructuring of health care to address: cost, quality, access and patient experience. Surrounding the image are stars indicating other elements of a reformed health care system which include health IT, evidence, system design, self management, team-based care and links to the community.

Slide 7

"PCMH" is a Term.

• ...to describe a pathway to excellent health care
• ...to re-claim a role as advocates for our patients (with our patients & their families)
• ...to encourage team-based care
• ...to create educational opportunities
• ...to attract medical students and residents to primary care

Slide 8

The Joint Principles of the PCMH

• Personal physician
• Physician directed medical practice
• Whole person orientation
• Care is coordinated and/or interated
• Quality and safety
• Enhanced access to care
• Payment to support the PCMH

Image includes 7 bullets of the PCMH Joint Principles with a bracket extending from the bullet: "Physician directed medical practice" lists many different members of the team described.

Slide 9

Patient-Centered, Physician-Guided Care

Image: Concentric circles illustrate the concept with the patient/physician relationship at the core.

Slide 10

Core of Team-Based Care

Image: Concentric circles illustrate the concept with the patient/physician relationship at the core.

Slide 11

Health 2.0 - Who is Using the Internet?

• 74% of Americans go online
• 61% of adults look online for health information
• For health/medical issues:
  • 86% of all adults ask a health professional
  • 68% of all adults ask a friend or family member
  • 57% of all adults use the internet
  • 54% use books or other printed reference material

Source: Pew Internet & American Life Project
http://www.pewinterent.org/reports/2009/8-The-Social-Life-of-Health-Information.aspx
 

Slide 12

Health 2.0 - Impact on Decisions/Actions

• Of the 60% who use online health information (e-patients):
  • 60% say the information affected a decision about how to treat an illness or condition
  • 53% say it led them to ask their physician new questions or to get a second opinion
  • 49% say it changed the way they think about diet, exercise, or stress management
  • 60% say they or someone they know has been helped

Source: Pew Internet & American Life Project
http://www.pewinterent.org/reports/2009/8-The-Social-Life-of-Health-Information.aspx

Slide 13

The New PCMH Team?

Image: A Venn diagram with three circles labeled as "Patient Team", "Health 2.0" and "Practice Team." These are enclosed in a shape consistent with a "home" with the implication being that the Patient Team, Practice Team, and Health 2.0 on the Internet could be considered the new PCMH team. 

Slide 14

Practice Implications

• Challenges of transformation
• Initial capital and restructuring costs
• Ongoing support & maintenance
• Reporting on quality, cost and satisfaction
• Implementation of HIT coincident with PCMH
• Cultural change
• Information overload
• Shift/sharing of "power"

Slide 15

Strengths:

• Patient-centered model
• Emphasizes use of evidence-based medicine
• Reason to expect that it will improve quality & bend the curve on costs
• Payment models decrease incentive for volume and encourage investment in practice changes to promote quality

Weaknesses:

• Requires considerable change in practice
• Data pending on practicality
• Unknown return on investment
• May disenfranchise small practices
• Workforce projections for primary care

Opportunities:

• Demonstration projects including public & private payers
• Collaboration with other professions and across specialties
• Health information technology
• Modeling of different payment models and organizational structures

Threats:

• Perception that this is a zero-$um game
• Depends on primary care workforce
• Consumers may not understand/accept the model (or name)
• Unintended consequences

Slide 16

A Commitment to Excellence

• Patient-centered communication
• Shared decision making
• Timely access to care
• Transparency & accountability
• Electronic health records
• Use of comparative effectiveness research & evidence-based guidelines
• Safety
• Measure, improve, measure

Slide 17

Image: An archer shooting for the stars.