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1. The Patient Centered Medical Home in the Information Age STFM NorthEast Region Meeting
October 31, 2009
Ted Epperly, M.D.
Program Director and CEO,
Family Medicine Residency of Idaho – Boise, Idaho
Clinical Professor of Family and Community Medicine
University of Washington School of Medicine
Board Chair
American Academy of Family Physicians
2. Health Care Reform Coverage
Cost
Insurance
Delivery
3. Five Ages of Civilization
4. Simple Rules for the 21st Century Health Care System
5. Simple Rules for the 21st Century Health Care System
6. America’s Rankings
7. $2,300,000,000,000
8. National Health Spending in Billions
9. Health Spending Everything Else
16. Rationale for the Benefits of Primary Care for Health Greater Access to Needed Services
Better Quality of Care
A Greater Focus on Prevention
Early Management of Health Problems
Cumulative Effect of Primary Care to more Appropriate Care
Reducing Unnecessary and Potentially Harmful Specialist Care
17. Rationale of a Primary Health Care Based System Decreased Morbidity and Mortality
More Equitable Distribution of Health in Populations
Lower Cost of Care
Better Self-Reported Health
Primary Care Physicians achieve Better Outcomes than do Specialists at much Lower Costs
Increasing the Number of Specialists is Associated with Lower Quality, Increased Cost, Increased Morbidity, and Increased Mortality
18. “Too many specialists are as dangerous to the quality and quantity of medical care in a community as too few.”
- Stanley R. Truman, M.D.
President Elect AAGP
September 13, 1949
19. Medicine Work Force
20. Number of Physicians Per Capita
21. Which System is More Stable?
22. Why? Salary
Lifestyle
Increasing Medical School Debt
Perceived Prestige
Rising Overhead
Unfunded Mandates
23. The Future of Family Medicine Charge “Develop a strategy to transform and renew the specialty of family practice to meet the needs of people and society in a changing environment.”
24. New Model of Family Medicine Personal Medical Home
Patient-Centered Care
Team Approach
Elimination of Barriers to Access
Advanced Information Systems
Redesigned Offices
25. New Model of Family Medicine (cont’d) Whole-Person Orientation
Care Provided within a Community Context
Emphasis on Quality and Safety
Enhanced Practice Finance
Commitment to Provide Family Medicine’s Basket of Services
26. Joint Principles of the Medical Home (AAFP, ACP, AAP, AOA) Personal Physician
Physician Directed Medical Practice
Whole Person Orientation
Care is Coordinated and Integrated
Quality and Safety are Hallmarks
Access is Enhanced
Payment Reform
27. Patient Centered Medical Home Place
Process
28. Family Medicine Value Continuity
Comprehensiveness
Coordination
Integration
29. FamilyPhysician
30. Payment The current United States health care system fails to deliver comprehensive primary care because of the way primary care is financed.
The payment structure will be based on a blended payment model.
31. Fee-For-Service Fee-for-service payments will continue for face-to-face visits. (Payments for care management services that fall outside of the face-to-face visit, as described below, should not result in a reduction in the payments for face-to-face visits). These payments encourage physicians to remain accessible to patients.
32. Care Management Fee All levels of Patient Centered Medical Homes will receive payment, through a care management fee. The amount of the fee will increase for each of the levels of designation (1, 2 and 3 based on the NCQA designation).
33. Pay for Performance A performance-based payment will recognize achievement of quality and efficiency goals through pay for reporting and pay for performance mechanisms.
34. Family Medicine: Unique Value Proposition Creation of a Medical Home
Improved Access
Relationships and Continuity
Focus on Prevention and Health Promotion
Early Management
Decreased Morbidity and Mortality
More Equitable Distribution of Care
Integration and Coordination
Better Quality of Care
Lower Cost of Care
35. Family Medicine’s Value
36. “The only limit to our realization of tomorrow will be our doubts of today, so let us move forward with strong and active faith.”
- Franklin D. Roosevelt
37. “Never, never, never, give up.”
- Winston Churchill