The Patient Centered Primary Care Collaborative Major Employers, Consumers and Physicians Unite to R

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The Patient Centered Primary Care Collaborative
Major Employers, Consumers and Physicians Unite
to Revolutionize the Healthcare
System Edwina Rogers, Vice President for
Health Policy
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Patient Centered Primary Care Collaborative
Table of Contents

• The Problem
• Collaborative
• Steering Committee
• Medical Home Definition
• Overview
• Joint Principles Statement
• Evidence of Quality and Efficiency Improvements
• North Carolina Medicaid
• Denmark
• Pilots
• Legislative Agenda
• Private Sector Implementation
• New Benefits Platform

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The Problem

• Employers want to buy high quality healthcare for
  their employees. Employers cannot buy the model
  of care they want for their employees.
• The reimbursement system is inadequate, the IT is
  insufficient, the accountability and incentives
  are not in place.
• This is why we created the PCPCC and want change.

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So we built a team, got together with the
providers, patients and the payers, discussed
what we want to buy, and set out forming a
collaborative to design and implement a new
system one that focuses on primary care and the
medical home.
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Steering Committee

• The PCPCC Steering Committee consists of
  organizations who agree with the joint principles
  and have invested time and resources to make the
  idea a reality.

American College of Physicians American Academy
of Family Physicians
The ERISA Industry Committee IBM Walgreens
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The Medical Home Definition

• Superb Access to Care
• Patients can easily make appointments and select
  the day and time. Waiting times are short. E-mail
  and telephone consultations are offered.
  Off-hours service is available.
• Patient Engagement In Care
• Patients have the option of being informed and
  engaged partners in their care. Practices provide
  information on treatment plans, preventative and
  follow-up care reminders, access to medical
  records, assistance with self-care, and
  counseling.
• Clinical Information Systems
• These systems support high-quality care,
  practice-based learning, and quality improvement.
  Practices maintain patient registries monitor
  adherence to treatment have easy access to lab
  and test results and receive reminders, decision
  support, and information on recommended
  treatments.

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The Medical Home Definition

• Care Coordination
• Specialist care is coordinated, and systems are
  in place to prevent errors that occur when
  multiple physicians are involved. Follow-up and
  support is provided.
• Team Care
• Integrated and coordinated team care depends on
  a free flow of communication among physicians,
  nurses, case managers and other health
  professionals. Duplication of tests and
  procedures is avoided.
• Patient Feedback
• Patients routinely provide feedback to doctors
  practices take advantage of low-cost,
  internet-based patient surveys to learn from
  patients and inform treatment plans.
• Publicly Available Information
• Patients have accurate, standardized information
  on physicians to help them choose a practice that
  will meet their needs.

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The Collaborative Overview

• The Collaborative will soon go public with a
  press release that includes signatories to the
  Joint Principles.
• The PCPCC Web Site will be located at
  http//www.PatientCenteredPrimaryCare.org.
• The PCPCC has held in-person meetings in
  Washington DC last October, January, March, and
  will hold another on June 11th.
• ERIC hosted Focus-On calls for the PCPCC, and
  will have more.
• The Patient Centered model is part of major
  employers New Benefits Platform.
• The PCPCC has an aggressive legislative agenda
  that centers on promoting the medical home
  concept and providing incentives for major payers
  to adopt this model.
• There is a weekly call for interested parties
  every Thursday morning at 1100am Eastern time.
  The call-in information is [phone],
  Passcode 421814. All organizations are welcome.

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Joint Principles of the Patient Centered Medical
Home

• The PCPC Collaborative is recruiting trade
  associations, major employers, provider groups
  and consumers to sign on
• Signed by 4 groups in March 2007 AAFP, AAP,
  ACP, AOA
• Principles
• Ongoing relationship with personal physician
• Physician directed medical practice
• Whole person orientation
• Care across the health system is coordinated
• Quality and safety
• Enhanced access to care
• Payment recognizes the value added

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Evidence of Quality and Efficiency Improvements

• North Carolina Medicaid
• Denmark
• GE Bridges to Excellence
• Veterans Administration
• Pilots (Medicare, IBM, Boeing)

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Big Savings for North Carolina

• North Carolina Medicaid redesigned their Medicaid
  system around the medical home and saved 225
  million the first year.

AccessCare Network Sites
AccessCare Network Counties
Access II Care of Western NC

• Focuses on improved quality, utilization and cost
  effectiveness of chronic illness care
• 15 Networks with more than 3500 Primary Care
  Physicians (1000 medical homes)
• Over 775,000 enrollees

Access III of Lower Cape Fear
Community Care of Wake and Johnston Counties
Central Care Health Network
CCNC Networks as of November 2006
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North Carolina MedicaidState Fiscal Year 2004
Savings
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NC Medicaid Drastic Quality Increase

• Key Attributes
• 24 hour access Provide or arrange for
  hospitalizations Coordinate and facilitate care
  for patients Collaborate with other community
  providers Participate in disease management,
  quality, and prevention projects Serve as a
  single access point for patients
• Role of Networks
• Assume responsibility for patients Implement
  improved care management and disease management
  systems Identify costly patients and services
  Develop and implement plans to manage utilization
  and cost Create the local systems to improve
  care and reduce variability
• Keys to Success
• Medical and administrative committees that
  provide direction on local care management
  activities Dedicated case managers to carry out
  such population management activities as risk
  assessment, case management, and disease
  management Care management processes that apply
  both new and existing resources, such as health
  department support services, in meeting the needs
  of enrollees Regular reporting and profiling of
  target initiatives that allow networks to monitor
  their progress in achieving target goals

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Revolution in Denmark
Denmark MedCOM Transformation Selected
Results FY 1992-2007

• Implemented universal - Patient Centered Primary
  Care 1992
• System wide universal eHIT with clinical decision
  support started 1993
• Denmark is the most advanced country in the world
  for clinical information technology systems in
  primary care
• Efficiency of hospital transfer from 7 hours to
  seconds
• Decreases in administrative cost to 1.3 Vs. 31
  USA
• Lowest medical error rate in the World .2 chance
  of death in Danish healthcare system do to
  medical error
• Euro eHealth award 2002, 2003, 2004, 2005
• Satisfaction at 94 highest in Europe in 2006
• Transparency Hospital, Doctors ranked by
  outcomes
• In Denmark, the doctor has the complete history
  available. No matter where a patient visits a
  doctor, their electronic health record is
  available. This level of comfort is to be found
  nowhere else in the world. YET
• Visiting with dozens of citizens, they all love
  their doctor and dont want to leave them

• Data source commonwealth fund/NZMJ 09/06/MOHI
  Denmark10/06/New England Journal of Medicine 8/03

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Denmarks Incredible Health IT
Patient Journal, Personalized Web-Page, Central
Server for Communicating Patient Records,
Providers Can Access the Records On Portable
Devices (PDAs, Tablet PCs, etc.)
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Denmark Better Healthcare with IT

• Fewer Medical Errors
• Emergency Personnel Can Check for Allergies
• Remote Monitoring and Case Management
• Reduces Unnecessary and Repetitive Treatments
• Enable Continuity of Care, Eliminate Waste
• E-Visits, Better Scheduling of In-Person Visits
• Compliance with Evidence-Based Medicine
• Reduce Costs, Drive Efficiency of Services
• Better Prevention, Better Risk Management, Better
  Outcomes

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Medical Home Pilots in the US

• IBM The Austin Project with American College of
  Physicians
• Boeing The Seattle Projects
• GE Collaboration with Bridges to Excellence
• Medicare Pilots to be developed over next 24
  months
• Medicaid NC implementation is so successful that
  state is considering rolling in SCHIP and state
  employees
• Veterans Administration Full implementation
  highly successful at driving quality and
  controlling costs

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Legislative Initiatives

• Medicare Demonstrations from H.R. 6111 Tax
  Relief and Health Care Act Further Medicare
  implementation
• Medicaid NC, MO, LA already planning and
  implementing Transformation Grants
• S-CHIP Possible Demonstrations Language to
  encourage transition to medical home model
• Health IT Legislation Medical home language,
  encouragement for physicians to adopt support
  systems
• Quality Improvement Organization 9th Scope of
  Work Language
• Medicaid Transformation Grants

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Private Sector Implementation

• PCPCC will design new reimbursement and
  value-based purchasing models.
• Primary care trade associations are working to
  ensure full participation by the physician
  community.
• Stakeholders will work with health plans to
  design products major employers want to buy.
• Successful pilots will encourage widespread
  adoption by private sector and public sector
  payers.

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Harnessing the Power of 5 Ps

• We want Purchasers of healthcare, Primary care
  physicians, and Patients to all agree on a high
  quality Product, and an internet Portal that
  could provide the glue to bring them together.

It exists elsewhere Denmark is the best
example. We can do it here look at NC Medicaid,
IBMs pilot in Austin, Boeings pilot in Seattle.
Now we just have to come together and build it
throughout the United States.
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The New Benefits Platform

• Leaders and visionaries in the business community
  have come together to develop a new way to
  deliver employee benefits.
• The New Benefits Platform (NBP) is centered on
  super administrators who take on liability from
  major employers and specialize in offering
  retirement, health, and other benefit plans.
  Employers will contribute a set dollar amount to
  employees chosen administrators, and employees
  could also contribute.
• NBP benefits would be portable, would include the
  tenets of Value-Driven Health Care (health IT,
  quality and cost transparency, and incentivizing
  healthy living), and would also center on the
  medical home and Patient Centered Primary Care
  model.
• Small employers and individuals could buy into
  NBP plans, which would include standardized
  minimum health and pension (direct contribution
  and defined benefit) plans, as well as lifetime
  security accounts and other benefits employers
  and employees could select.

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Mark Ugoretz, President CEOEdwina Rogers,
Vice PresidentMore information on ERIC
OnLine www.eric.org1400 L Street, NW Suite
350 Washington, DC 20005-3509Phone (202)
789-1400 Fax [phone]