Patient Centered Medical Home

1. Patient Centered Medical Home

2. Something has got to give……health costs a factor in US Competitiveness

3. While others struggle to reform health care, we can’t wait – Oklahoma is moving ahead and transforming now….

4. Over past 25 years, only State with worsening Age-adjusted Death Rates Tulsa and Oklahoma • Oklahoma: • Last in the US in health system performance. • Only state with worsening death rate. • Last in US in physicians per capita. • Tulsa - 14 year difference in life expectancy. • Upper quarter of health care spending. • Innovative health system and insurance expansions. OU School of Community Medicine: • Nation’s first School of Community Medicine • Serves as the region’s platform for change • Goal – Improve health of entire communities; • Recruit for and maintain altruism – MDs, PAs, Nurse Practitioners – using clinical experiences, scholarship and loan payback efforts to motivate. • Curriculum – add public health, systems engineering, student run clinical services. • Expansive network of innovative primary care, specialty care programs out in neighborhoods most in need - e.g. 19 school based clinics. • Patient Centered Medical Home – for uninsured and Medicaid populations implemented. • Partners with OU social work, early childhood education, school systems, urban planners etc. • Health Information Technologies – patient to doctor, doctor to doctor: reduced need for face to face visits by 52%. Consortia in place for Health Information Exchange and Health Information Coordination. US Death Rate 14 year difference In life expectancy between North and South Tulsa

5. TODAY’S CARE MEDICAL HOME CARE My patients are those who make appointments to see me Our patients are those who are registered in our medical home Patients’ chief complaints or reasons for visit determines care We systematically assess all our patients’ health needs to plan care Care is determined by today’s problem and time available today Care is determined by a proactive plan to meet patient needs without visits Care varies by scheduled time and memory or skill of the doctor Care is standardized according to evidence-based guidelines Patients are responsible for coordinating their own care A prepared team of professionals coordinates all patients’ care I know I deliver high quality care because I’m well trained We measure our quality and make rapid changes to improve it Acute care is delivered in the next available appointment and walk-ins Acute care is delivered by open access and non-visit contacts It’s up to the patient to tell us what happened to them We track tests & consultations, and follow-up after ED & hospital Clinic operations center on meeting the doctor’s needs A multidisciplinary team works at the top of our licenses to serve patients

6. Medical Care 2000 Diagnostic Testing & Imaging Specialty Dx/Rx Services Surgical & Intensive Services Urgent Care Services Primary Care Services HEALTH CARE SYSTEM Wellness & Fitness Clubs Pharmacy & Health Foods Chronic Disease Service

7. Medical Homes 2009 Diagnostic Testing & Imaging Specialty Dx/Rx Services Surgical & Intensive Services Patient-Centered Medical Home: Urgent Care Services Primary Care Services HEALTH CARE SYSTEM Wellness & Fitness Clubs Pharmacy & Health Foods Chronic Disease Service

8. Health Information Exchange 2010 Diagnostic Testing & Imaging Specialty Dx/Rx Services Surgical & Intensive Services EMR & HIE Web-based Communication Portals Decision Support Patient-Centered Medical Home: Wellness Evaluation & Plan Urgent Care Services Primary Care Services HEALTH CARE SYSTEM Wellness & Fitness Clubs Pharmacy & Health Foods Chronic Disease Service

9. Advanced Medical Home 2011 Diagnostic Testing & Imaging Specialty Dx/Rx Services Surgical & Intensive Services EMR & HIE Web-based Communication Portals Decision Support Team Based - Primary Care Health Information Integration / Coordination Urgent Care Services HEALTH CARE SYSTEM Wellness & Fitness Clubs Pharmacy & Health Foods Chronic Disease Service

10. Lessons: Medical Home Teamwork • New roles and responsibilities • Everyone functions at the top of their license • New teamwork roles for students and residents • New work flow • Team meetings for planning and improvement • Continuous training, learning, and improvement • Non-visit “touches” deliver pro-active, planned, coordinated, and integrated care • Data driven work – not visit driven work • New Approach to quality and safety • Eliminate re-work • Eliminate duplicated effort • Eliminate work-a-rounds

12. Lessons: Project Management as the Implementation Strategy 35% 48% 17% 50% 44% 6% 70% 30%

13. Announcement Implementation Successful Progress/Projects ENERGY / SUPPORT Planning Culture Crisis TIMELINE Our Organization’s Enthusiasm Levels: A Project Lifecycle Mar ‘09 Sept ‘08

14. Getting Organized - “Tulsa Health” (black = established, blue = in development or proposed) Front Doors to Care Primary Care Clinics and Medical Homes Intensive Outpatient Programs • Emergency Rooms: • Saint Francis Hospital • St. John Medical Center • Hillcrest Medical Center • OSU Medical Center I N S U R E O K L A H O M A -- MEDICAID • OU Bedlam Longitudinal Clinic – PCMH Model • 6 sessions / week • OU School-based Clinic = 19 sites – PCMH Model • OU Housing Authority Clinics = 2 – PCMH Model • OU Micro-clinics – Day Center for the Homeless – 5 days • per week • Neighbor for Neighbor, Neighbors Along the Line, • OU Physicians Clinics – Hillcrest – PCMH • Schusterman Center - PCMH • OSU Physicians Clinics – SW Boulevard, Houston Park • OSU Physicians – Country Club Gardens • Morton Clinics – FQHC – Lansing Park, East Tulsa • Community Health Connections – FQHC - East Tulsa, • 3rd and Lewis. • Patient Centered Medical Home Patient Portal with IBM • Greater Tulsa Health Access Network – Greater THAN – • Health Information Exchange and Care Coordination • PACT Teams – Severe mental illness • COPES Team – Emergency Psychiatry • ER Frequent Flyer Team – • Multiple medical illnesses • Acute – Walk In Care: • OU Bedlam Evening Clinics • OU Bedlam Evening Pharmacy • OU Bedlam Evening Clinics • Case Management and Referral • Programs • Good Samaritan Clinics Specialty Care • MAP / Voucher Specialty Care Network • Northland Imaging Center • OU Physicians Clinics at St. John, Saint Francis • and Hillcrest Medical Centers, • OU Schusterman Center Clinics • OSU Physicians Clinics at OSU MC, • Houston Park, SW Boulevard • OU OB Outreach – e.g. Margaret Hudson. • Porter, Community Health Connections • OU Xavier Breast Health Clinic • OU Bedlam Specialty Clinics – Derm, HIV, • Gynecology, Hep C • Heart Intervention Project • OU Diabetes Center • OU Cancer Institute • OU Tisdale Specialty Health Center • Doc 2 Doc e-consultations between primary care • and specialists Safety Net Clinics • ER Diversion Programs: • OU Tisdale Health Center • Urgent Care Clinic • OU ER Diversion and • Follow Up Clinic • OSU / St. John Program Pharmacy Services • Tulsa County Pharmacy • OU STEP Pharmacy • OU Bedlam Pharmacist Program and • 5 community pharmacies Prevention Initiatives • 211 Line • Baby Line • OU Nursing Prenatal Care • Harvard Project - Cycle • of Poverty • PENN Project – Anchor • Community Schools Clancy 8 / 2009