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  1. HOME SWEET MEDICAL HOME Brian T. Engel, MD Pediatrician, Northpointe Pediatrics Chairman, St John Medical Group PGIP

  2. Introduction • Patient-Centered Medical Home (PCMH) Defined • PCMH-The Past • PCMH-The Present and The Future • PCMH Success • Northpointe Pediatrics PCMH • Challenges • Summary

  3. American Academy of Pediatrics (AAP), 1967 • A medical home is primary care that is accessible, continuous, comprehensive, family centered, coordinated, compassionate, and culturally effective

  4. Home Sweet Medical Home, 2009 • Your medical home at Northpointe Pediatrics is a place that can take care of all your children’s health care needs from “cradle to college”. However, it is more than a place; it is a continuous relationship with your child’s pediatrician and our team of medical professionals that puts the patient at the center of care.

  5. PCMH-The Past • Pre-1980: Fee-For-Service Model • High costs, trust of physicians and “the system” is high (blind faith?) • 1980’s and 1990’s: Managed Care Model and Gatekeepers • Lower costs, but distrust of physicians and “the system” soars (rationing care?) • Early 2000’s: Hybrid Model (Modified FFS/Managed Care) • Costs escalating, distrust rampant (Gatekeeper is dying breed)

  6. PCMH-The Present and The Future • “Back to the future” • Re-birth of the PCMH (Designations by NCQA 2008 and BCBSM 2009) • Out with the bad: • The Gatekeeper is dead and buried • In with the good: • Re-establishing respect and trust between patients, physicians and payers • Primary care physicians (PCPs) are patient advocates that can help the patient and their families navigate the heath care system

  7. PCMH Success • We all must change our way of thinking… • Wheezing ≠ Allergist or ER visit • Zits ≠ Dermatologist visit • Sprained ankle ≠ Orthopedic or ER visit • Obesity ≠ Gastric Bypass • Success depends on the mutual respect, trust and cooperation between the patient, the PCP (and his/her team), the specialists and the payers

  8. Northpointe Pediatrics PCMH • Childhood Obesity • The problem: • 75% of health care dollars ($1.5 trillion) are spent on chronic conditions • In 1998 $74 billion was spent on obesity-related conditions and in 2008 $147 billion was spent • 33-35% of kids are overweight (BMI>85%), 17-20% of kids are obese (BMI>95%) • Our solution: • Chronic Care Travel Team (with Medical Network One) was established in 2006 with a focus on Individual Care Management • The CCTT is a physician-lead team which includes an RN, Dietician, Exercise Specialist and a Wellness Counselor

  9. Northpointe Pediatrics PCMH • Asthma Registry • The problem: • PCPs (like us) were doing a good job, but not a great job, of managing chronic conditions like asthma • Our solution: • An Asthma Registry: an electronic database to monitor and manage ALL our asthmatic patients which is available at the point-of-care; the registry incorporates evidence-based guidelines

  10. Northpointe Pediatrics PCMH • Physician Dispensing • The problem: • Our patients would at times leave our office and either be non-compliant (they didn’t fill the medication prescribed) or experience medication errors • Our solution: • In 2006 we started dispensing medications at the point-of-care in a our office; since then, we have seen improved patient compliance, reduced medication errors, lower costs for the patient and the payers (our GUR is 87%) and improved patient satisfaction

  11. Northpointe Pediatrics PCMH • Patient Portal • The problem: • Poor communication between physicians and their patients • Patients need a secure, confidential and portable Patient Health Record (PHR) • Our solution: • Our Patient Portal, RelayHealth, allows online communication between our office and our patients • Patients and their family members have free access to a PHR • Patients can request online prescription refills and renewals, specialist referrals, appointments, and web visits

  12. Northpointe Pediatrics PCMH • Performance Reporting • The problem: • Insurers data about key chronic conditions and preventative care showed “gaps in care”; most of the “gaps” were opportunities to improve care, some of the “gaps” were from poor data collection • Our solution: • Our registries for chronic conditions (like asthma) and preventative care (MCIR, BCN’s Health-e Blue, HAP’s Member Health Manager) help us implement care delivery systems that outreach to patients and close “gaps in care” • The outcome: Patients benefit (care is better and proactive rather than reactive), physicians benefit (P4P dollars and better work flows for improved patient care), payers benefit (healthier patients and lower costs)

  13. Challenges • Childhood Obesity • Obesity is still not a billable code • BCBSM/BCN are the only insurers that recognize the CCTT with payments (T-codes) • Asthma Registry • Some patients are suspicious of “specialist” care by their PCP • Some specialists feel threatened by a loss of business, but shouldn’t be • Physician Dispensing • Although physician dispensers are contracted participants of the Good Neighbor Pharmacy Provider Network (GNPPN), the entity is still not universally recognized by insurers

  14. Challenges • Patient Portal • Even though we deal with the “techie” generation, only 20% of our 12,000 patients communicate with us online • Are Obama’s “meaningful use” stimulus dollars for EMR attainable? • Performance Reporting • An inherent conflict exists: while physicians are promoting the PCMH concept, some insurers are still “rewarding” patient care outside the PCMH (no ER co-pays, Urgent Care check-ups, Minute Clinic visits)

  15. Summary • The PCMH is the answer to our health care woes in primary care • We can achieve quality patient-centered medical care in a cost-effective fashion • To do so, we must go “back to the future” and re-establish a trusting and cooperative relationship between patients, physicians and payers • Change is hard, but change is good!