Tad P. Fisher Executive Vice President Florida Academy of Family Physicians

1. Patient Centered Medical Home A Medicaid Managed Care Alternative Tad P. Fisher Executive Vice President Florida Academy of Family Physicians

2. The Reality: The healthcare world is changing in ways that many of us have never seen in our lifetime, with the possible exception of Medicare.

3. “It is not the strongest of the species that survives, nor the most intelligent, but the one most responsive to change.” Charles Darwin

4. There will be winners and losers at all levels as a result of healthcare (health insurance) reform.

5. Today Today Pilots Today 2013 Pilots* 2012 Pilots* *Medicare Pilots – waiver of anti-trust & anti-kickback Source: The Advisory Board, 2010 Source: Advisory Board

6. Patients Why PCMH matters ---PCMH Pilot Outcomes • Improved satisfaction • Improved preventive care • Improved quality measures • Reduced ED utilization • Reduced readmissions • Reduced hospitalizations • Longer team-based appointments; enhanced communication • Reduced per capita cost for certain chronic conditions Physicians & Staff Happier staff Happier physicians Increased net revenue Increased take-home pay in today’s environment Team-based care Decreased panel size? Relatively rapid returns from transformation Increased standardization of care

7. Evolution of Expectations Team-based care Focus on the top of license/training & interest Improved communication Improved data flow & access Right patient at the right time Patient-centered aligned incentives – outcomes, quality, cost External accountability – outcomes, quality, cost

8. Principles of The Patient Centered Medical Home Personal Physician trained to provide continuous, comprehensive care Physician-Directed Medical Practice Whole Person Orientation Coordinated Care Quality and Safety Enhanced Access to Care Payment appropriately recognizes added value provided to the overall system

9. Why Patient Centered Medical Home • The Patient Centered Medical Home creates a framework for change • The Patient Centered Medical Home creates a common language for change • The Patient Centered Medical Home creates an opportunity for change

10. Access to Care &Information • Health care for all • Same-day appointments • After-hours access coverage • Accessible patient and lab information • Online patient services • Electronic visits • Group visits • Practice Management • Disciplined financial management • Cost-Benefit decision-making • Revenue enhancement • Optimized coding & billing • Personnel/HR management • Facilities management • Optimized office design/redesign • Change management • Practice-Based Services • Comprehensive care for both acute and chronic conditions • Prevention screening and services • Surgical procedures • Ancillary therapeutic & support services • Ancillary diagnostic services • Health Information Technology • Electronic medical record • Electronic orders and reporting • Electronic prescribing • Evidence-based decision support • Population management registry • Practice Web site • Patient portal • Care Management • Population management • Wellness promotion • Disease prevention • Chronic disease management • Patient engagement and education • Leverages automated technologies • Quality and Safety • Evidence-based best practices • Medication management • Patient satisfaction feedback • Clinical outcomes analysis • Quality improvement • Risk management • Regulatory compliance • Care Coordination • Community-based services • Collaborative relationships • Emergency room • Hospital care • Behavioral health care • Maternity care • Specialist care • Pharmacy • Physical Therapy • Case Management • • Care transition • Practice-Based Care Team • Provider leadership • Shared mission and vision • Effective communication • Task designation by skill set • Nurse Practitioner / Physician Assistant • Patient participation • Family involvement options

11. What We Have Learned (and are learning) Access to Care and information Practice Level Services Care Management Continuity of Care Services Practice Based Team Care Quality and Safety Health Information Technology Practice Management Patients

12. TeamworkFive Core Teamwork Competencies: • Trust • Ability to constructively manage conflict • Commitment to both one’s own job and the larger mission • Ownership and accountability – everyone is a leader in their own area. • Follow-through

13. The “Medical Neighborhood” Collaborative Care Coordinated Care Shared Responsibilities Community Resources Team Care in and outside the practice Interoperable Technology Shared vision/alignment Education

14. The result of the goals of higher quality, better coordinated, more efficient care via PCMH Improved Outcomes! a. Quality b. Chronic Disease c. Transitions in care d. Satisfaction e. Efficiency (cost savings) f. Practice Financials

15. Great Outcomes Patients Office Staff Physicians Community Culture of Improvement Performance Measurement Reliable Systems Quality Built In Patient Service Convenient Access Personalized Care Care Coordination Practice Management Health IT Process Automation (EHR) Communication Connectivity EBM Support Clinical Information Systems Financial Personnel Clinical Systems Primary Care Continuous Healing Relationship Whole Person Orientation Family and Community Context Comprehensive Care

16. PCMH: ….Because everyone deserves a Medical Home! Terry McGeeney, CEO, TransforMED