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Building a Medical Neighborhood We All Want to Live and Work In

Building a Medical Neighborhood We All Want to Live and Work In. Asaf Bitton MD, MPH, FACP Division of General Medicine, Brigham and Women ’ s Hospital Harvard Medical School Center for Primary Care February 25 th , 2013 abitton@partners.org. A Challenge To You.

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Building a Medical Neighborhood We All Want to Live and Work In

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  1. Building a Medical Neighborhood We All Want to Live and Work In Asaf Bitton MD, MPH, FACP Division of General Medicine, Brigham and Women’s Hospital Harvard Medical School Center for Primary Care February 25th, 2013 abitton@partners.org

  2. A Challenge To You • Be ruthlessly specific and focused today • “What are we doing next Tuesday?” • “What are we doing Tuesday, April 23rd?” • Do not fear “impossibility” • Just a state of mind • What are the “good enough” solutions? • Prioritize • Leave here with a tangible plan • What you do matters for CO and the rest of the country

  3. Our Core Questions • What business are we in? • Where do we want to go?

  4. Historical Perspective 1932: Committee on the Cost of Medical Care • Organize groups of providers • Increase disease prevention • Distribute costs through voluntary insurance • Form community agencies to coordinate care services • Improve professional education for providers

  5. Where We Are Going Hospital Sub-Acute Care HIT HIT Sub-specialty PCMH Sub-specialty “Medical Home Neighbor” Sub-Specialty Procedural Practice HIT HIT Patient-Centered Medical Home HIT HIT HIT

  6. Four Building Blocks for Better Primary Care • Teams • Build, augment, or revise: You can’t do this alone • Leadership • Vision, planning, and finding resources • Quality Improvement Method • Having an ordered way to change together • Empanelment • Knowing who the team takes care of at all times

  7. Invention vs. Innovation • DC-3, 1935 Spitfire, 1931 • Kitty Hawk, 1903

  8. Five Key Functional Areas RELENTLESS FOCUS AROUNDCARE TRANSITIONS (ADT)

  9. Five Key Functional Areas • Connecting Providers Together

  10. Five Key Functional Areas Integrating Behavioral Health into Primary Care

  11. Five Key Functional Areas RISK-STRATIFIED, TEAM-BASED POPULATION MANAGEMENT • What population? • DM, High risk, Behavioral health • What care? • BP, A1c, ED/Hosp • Who participates? • CCRN,MA, LPN, PA, MD, SW, CHW • When? • Weekly/monthly

  12. Five Key Functional Areas • CHANGING PAYMENT

  13. Payment Change • Three Areas: • Enhanced, augmented primary care payment • Bundled payments • Accountable care arrangements

  14. Bauhaus Axiom of Health Care Finance (Bitton Variant) • Form Follows Finance

  15. Harbrecht Conjecture on Practice Change • We can transform primary care effectively, and have a playbook to do it

  16. Greenlee Postulate on Primary-Specialty Care Interactions • It’s a beautiful day in the neighborhood, and here is a platform for building it • PCMH-Neighbor

  17. Forrest’s Typology Five Roles • Cognitive consultation • Procedural consultation • Co-management with shared care • Co-management with principal care • Comprehensive Primary Care

  18. Issues to Consider Around Referrals • What’s a high value referral? • How do you measure it? • How do you incentivize for it? • How do we move from interventions aimed at making referrals better for doctors to making them better for patients and the system?

  19. Kendrick Maxim on Physician Connections • We can get docs to talk to each other electronically, and coordinate outside their office walls

  20. Gordon’s Proposition on Building Interconnected Communities • If you build it, they will connect • (and data exchange is the key)

  21. Grundy’s Law on Health Care Advocacy • Providers and Policymakers at rest will tend to stay at rest…so get them moving!!

  22. A Challenge to You • Be ruthlessly specific and focused today • “What are we doing next Tuesday?” • “What are we doing Tuesday, April 23rd?” • Do not fear “impossibility” • Just a state of mind • What is the “good enough” solution? • Prioritize • Leave here with a tangible plan • What you do matters for CO and the rest of the country

  23. Thank You! • Questions? Comments? • Email: abitton@partners.org

  24. PCMH Neighbor (ACP) • Specialists that communicate, coordinate and integrate bidirectionally with PCMH • Ensure appropriate and timely consultations and effective flow of information • Address issues of responsibility in pt co-mgmt • Support patient centered care • Support the PCMH practice as the provider of whole person primary care to the patient

  25. PCMH Neighbor (ACP) • How to get there? • Recognition process • Care Coordination Agreements • Define type of interaction • Responsibility for the elements of care • Expectations for information exchange

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