Med Home Port: Way Forward SG Conference January 21, 2011 RADM Karen Flaherty, Deputy Surgeon General

1. Med Home Port: Way Forward SG Conference January 21, 2011 RADM Karen Flaherty, Deputy Surgeon General RADM Donald Gintzig, Deputy Chief, Medical Operations, M3/5 RADM Matthew Nathan, Regional Commander, NCA RADM Alton Stocks, Regional Commander, NME RDML Forrest Faison, III, Regional Commander, NMW RDML Eleanor Valentin, Regional Commander, NMSC CAPT Maureen Padden FORCM Laura Martinez

2. History of PCMH • First coined by AAP in 1967 as central record • 2002: AAP expanded the concept • 2004: AAFP Future of Family Medicine project • 2005: IBM began to question healthcare costs • 2006: ACP Primary Care Medical Home Report • 2006: Joint Principles of the PCMH published by AAFP, AAP and ACP • 2006: Creation of the Patient Centered Primary Care Collaborative (PCPCC)

3. PCMH Strategy • Improve physician / patient relationship • Improve access, quality, control cost of care • Increased costs and poorer health outcomes when compared to other developing countries • U.S. ranks # 37 in quality but #1 in per capita costs • High utilization of technology/procedures in US: • Drives misperception that healthcare is too expensive • Overuse exposes patients to potential adverse events and errors

4. Outcomes of Implementing Patient-Centered Medical Home Interventions: A Review of the Evidence From Prospective Evaluation Studies in the United States Updated November 16, 2010 Kevin Grumbach, MD, Paul Grundy, MD, MPH • Group Health, Geisenger, VA, Blue Cross Blue Shield, Medicaid (NC, CO) and others… • Decreased PMPM • Decreased ER utilization • Decreased admissions • Improved quality metrics • Improved customer satisfaction (patients/staff)

5. Why Medical Home? • Crisis in patient satisfaction in MHS vs. network • Improve upon the great care we already provide • Mandate from higher echelons to improve the efficiency of Navy/Military Medicine • Unsustainable inflationary costs of medicine • “Medical Home is a game changer” (SG) • Is different in many ways from what we do now….. • Team based, comprehensive care • True population based health management • Cost control, not cost savings

6. Why Medical Home?

7. Challenges in Execution • PMO will provide the necessary subject matter expertise to assist MTF’s • We will support leadership at every level with change management guidance • Financial landscape presents challenges to be overcome by analysis, creativity, collaboration • Practice roles will be transformed in powerful ways; opportunities for health care team • We will ultimately alter what we recognize and reward; pilots present a hybrid model for the future

8. Short Term Goals • Innovation and creativity; transformation • Self reflection on current practices and “why?” • Recognition that the status quo must be changed • Accountable teams focused on patient centered access and continuity • Enhance patient and staff satisfaction • Improve prevention and readiness • Decrease ER / Urgent Care use • Reduce unnecessary specialty care use

9. Long Term Goals • Improve overall health and quality of care • Reduce unnecessary hospitalization • Recapture network enrollment when possible • Recapture high value network specialty care • Civilian experience suggests we could • Control (bend) the cost curve within a couple of years • Reduce inflation of Per Member Per Month (PMPM) • May be some upfront investment to see returns • NC Medicaid project • Healthier population greater expense long term

10. MHP Strategic Dashboard • Population Health • Diabetes • Asthma • Colon cancer • Breast cancer • Cervical cancer • Experience of Care • MHP Team Continuity • PCM Continuity • 3rd Next Available Acute • 3rd Next Available Routine • Patient Satisfaction • Staff Satisfaction • Per Capita Cost • PMPM (Clinic/Team) • ER Utilization • Urgent Care Utilization • Specialty Care Utilization • Enrollment / FTE • Readiness • Indeterminate • Fully Medically Ready 10 10

11. MHP PMO Way Forward • BUMED strategic communication plan to ensure consistent messaging regarding MHP • PMO Implementation Team expanding • Formalized training and execution plan for MHP • Med Home Port dashboard on MHS Insight • Roll out Care Point and Secure messaging • NCQA recognition: • Baseline self assessments • Collaborative journey through formal recognition

12. Why Medical Home?

13. Med Home Port Logo

14. “If you don't like change, you're going to like irrelevance even less." General Eric Shinseki (ret), Former Chief of Staff, U.S. Army Secretary of the Veteran’s Administration

15. More Information on PCMH • Session at MHS Conference on PCMH • Several tracks worth attending • In particular: • PCMH in the services (Track H) • Access to Care (Track H) • Enrollment (Track H) • Population Health Management (Track H) • Cultural Change in PCMH (Track H) • Financial incentives in PCMH (Track K)

16. Panel Discussion RADM Karen Flaherty, Deputy Surgeon General RADM Donald Gintzig, Deputy Chief, Medical Operations, M3/5 RADM Matthew Nathan, Regional Commander, NCA RADM Alton Stocks, Regional Commander, NME RDML Forrest Faison, III, Regional Commander, NMW RDML Eleanor Valentin, Regional Commander, NMSC CAPT Maureen Padden FORCM Laura Martinez / HM2 Swindle

17. Small Group Work • Each table has been assigned two distinct questions regarding implementation of MHP • 30 minute table discussion • Capture key issues, potential solutions • Prioritize top three recommendations • All tables will be asked to record recommendations • Several tables will be asked to report out