A New Model for Chronic Care Management A Community-based “Utility”

1. A New Model for Chronic Care ManagementA Community-based “Utility” Victor G. Villagra, MD, FACP Assistant Professor of Medicine Ethel Donaghue Center for Translational Research University of Connecticut Health Center President Health & Technology Vector, Inc.

2. DIABETES

3. COPD

4. Two Models of Disease Management OR Disease Management Chronic Care Model Practice Centered “MEDICAL HOME” Payer Sponsored “DISEASE MANAGEMENT”

6. Payer 1 Payer 2 Payer 3 Payer 4 Payer 5

7. Limited Financial Resources Labs Labs Payer 1 Health Literacy Payer 2 Specialist 1 Specialist 2 Hospital Payer 6 Specialist 6 Specialist 3 Labs Home Health Hospital Specialist 5 Specialist 4 Payer 3 Payer 5 Health Beliefs Patient Values Hospital Labs Labs Payer 4 = Patients

8. The Complex Role of • Primary Care Physicians • Delivery of Basic Primary Care……………… • Between Visits Supportive Care (DM)……… • Coordination of Care………………………… • No time • No data • No information systems • No mass communication infrastructure • Limited or no decision support • Limited staffing • No reimbursement

9. Payer 1 Payer 2 Payer 3 Payer 4 Payer 5

10. Payer 1 Payer 2 CHAOS THEORY Payer 3 Payer 4 Payer 5

11. MEDICALHOME MEDICALHOME MEDICALHOME MEDICALHOME MEDICALHOME Payer 4

12. Payer 2 Payer 5 MEDICALHOME MEDICALHOME MEDICALHOME MEDICALHOME MEDICALHOME No way! Payer 4 Payer 1 Payer 3

13. DIABETES

14. The Actual Patient Experience Health Care Providers Dr. # 1 Dr. # 2 Dr. # 3 Hospital Pharmacy #1 Pharmacy #2 Acupuncturist Health Store Diet Center Grocery Neighbor time Source: Dr. J.K. Jones, The Degge Group, Ltd.

15. Two Models of Disease Management OR Disease Management Chronic Care Model Practice Centered “MEDICAL HOME” Payer Sponsored “DISEASE MANAGEMENT”

16. Combined Model of Care Management AND Disease Management Chronic Care Model Practice Centered “MEDICAL HOME” Payer Sponsored “DISEASE MANAGEMENT”

17. A Community-based “UTILITY”

18. PROVIDERS PATIENTS A Community-based “UTILITY” PAYERS

19. A Community-based “UTILITY” SECURE STANDARIZED DATA CM DM MEDICALHOME MEDICALHOME DATA DATA DATA Between Visits Support Services Between Visits Support Services Payer 1 Payer 4 Payer 2 Payer 3 Payer 5

20. DATA b d a c A Community-based “UTILITY” DATA DATA $ DATA Funding for The Newly Insured DATA $

21. The Complex Role of • Primary Care Physicians • Delivery of Basic Primary Care……………… • Between Visits Supportive Care (DM)……… • Coordination of Care………………………… • No time • No data • No information systems • No mass communication infrastructure • Limited or no decision support • Limited staffing • No reimbursement

22. Open Issues PROVIDERS PATIENTS • Role • Rights • Responsibilities • A Community-based • “UTILITY” • Infrastructure • Funding PAYERS

23. A Community-based “UTILITY” Questions? Comments?