1 / 25

Advocating for Collaboative Care

Advocating for Collaboative Care. Collaborative Family Healthcare Association National Conference November 6-8, 2008 Alexander Blount, EdD. What do we have to sell?. Primary care’s track record already Data on behavioral health needs in primary care

nicholas-schneider
Télécharger la présentation

Advocating for Collaboative Care

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Advocating for Collaboative Care Collaborative Family Healthcare Association National Conference November 6-8, 2008 Alexander Blount, EdD

  2. What do we have to sell? • Primary care’s track record already • Data on behavioral health needs in primary care • Data on evidence of care management programs for depression in primary care • Data on improvement of productivity of people who get effective treatment for depression

  3. Primary care is our best venue for improving population health and for controlling medical cost. The Impending Collapse of Primary Care Medicine and Its Implications for the State of the Nation’s Health Care:A Report from the American College of PhysiciansJanuary 30, 2006

  4. Why do we need the concept of “Medical Home” We already know that primary care the way we teach people to do it is hot stuff. The Medical Home evidence is really describing well-run primary care. This is the first model that has drawn large physician groups, insurance companies and government agencies into agreement. http://www.pcpcc.net/

  5. Hierarchy of Evidence Strength Jenicek, 2006, Med Sci Monit 12: 241-251

  6. Hierarchy of Influence Strength Blount, unpublished musings

  7. What we need is a new familiar idea.“Home is the place where when you have to go there they have to take you in.”The Death of the Hired Man by Robert Frost

  8. US News & World ReportJuly 14, 2008 • Six Pennsylvania insurers, including Independence Blue Cross and Aetna, in May said they would spend $13 million over three years to pay doctors in 32 primary care practices to help them set up medical homes. • Minnesota's governor in May signed a law that will use state and private funds to pay primary care doctors who create medical homes. • Nationwide, 27 of 39 Blue Cross Blue Shield insurers are testing pilots of the model. • Employers such as IBM, Dow Chemical and General Motors joined doctors, insurers and the AARP to advocate medical homes.

  9. Evidence is accruing • When adults have a medical home, their access to needed care, receipt of routine preventive screenings, and management of chronic conditions improves substantially. • A medical home can reduce or even eliminate racial and ethnic disparities in access and quality for insured persons. • Patients with chronic diseases like diabetes, congestive heart failure, and adult asthma have fewer complications, leading to fewer avoidable hospitalizations. • Medical Home = well run primary care office Commonwealth Fund report (Beal, Doty, Hernandez, et al, June 2007)

  10. Medical Home = well run primary care office in CF survey • Patients who reported all 4 were considered to have a medical home • I have a regular doctor or source of care. • Not difficult to contact provider over the phone • Not difficult to get care or medical advice after hours • Doctor’s office visits are usually well organized and running on time

  11. And PCMH looks like a fiscal winner. The North Carolina Medicaid program enrolls recipients in a network of physician-directed medical homes. A Mercer analysis showed that an upfront $10.2 million investment for North Carolina Community Care operations in SFY04 saved $244 million in overall healthcare costs for the state.Similar results were found in 2005 and 2006.

  12. The (Public) Bottom Line • Care delivered by primary care physicians in a Patient-Centered Medical Home is consistently associated with: • better outcomes • reduced mortality • fewer preventable hospital admissions for patients with chronic diseases • lower utilization • improved patient compliance with recommended care • lower Medicare spending.

  13. The (Private) Bottom Line • The concept of the Medical Home gives us a shot at re-branding primary care. • Maybe we can remake the image of primary care after the era of “gatekeeping”. • We may have found a mechanism get payments not tied to service by the physician. • Unlike “capitation”, a PMPM that gives no incentive to restrict care • We have to get beyond “hamster care.” • Unless we fix access (urgent care, off hours phone, on time appointments), it isn’t a home anyone will want.

  14. The Patient Centered Medical Home “Defined”ACP, AAFP, AAP, AOA • Personal physician - each patient has an ongoing relationship with a personal physician trained to provide first contact, continuous and comprehensive care. • Physician directed medical practice – the personal physician leads a team of individuals at the practice level who collectively take responsibility for the ongoing care of patients. • Whole person orientation – the personal physician is responsible for providing for all the patient’s health care needs or taking responsibility for appropriately arranging care with other qualified professionals. This includes care for all stages of life; acute care; chronic care; preventive services; and end of life care. • Care is coordinated and/or integratedacross all elements of the complex health care system (e.g., subspecialty care, hospitals, home health agencies, nursing homes) and the patient’s community (e.g., family, public and private community-based services). Care is facilitated by registries, information technology, health information exchange and other means to assure that patients get the indicated care when and where they need and want it in a culturally and linguistically appropriate manner • http://www.pcpcc.net/content/joint-principles-patient-centered-medical-home

  15. Why Should Behavioral Health Be a Core Service? • Access – At least 50% better access to MH care if offered in primary care. (different from managing care across medical specialties) (Bartels, Coakley, Zubritsky, et al. Am J Psych, 2004) • Complex patients with chronic illnesses needing behavioral health care are more likely to be designated for Medical Home level of care. • Care in medical setting is a better cultural fit for many patients. • Behavioral Health Clinicians free up time for PCPs to spend with other patients, while enhancing patient satisfaction and self-efficacy. • Care management is more effective when done by professionals with behavioral health skills. (Pincus, Pechura, Keyser, et al. Administration & Policy in Mental Health. 33(1):2-15, 2006

  16. What are we missing • Evidence of impact of integrated practices rather than targeted integrated programs • A name/concept/description of integrated care that would make patients demand it • Implementation instructions that solves administrative and financial barriers (Everyone re-invents the same wheel). • Understanding of primary care behavioral health by most payers and administrators • An agreed upon list of necessary changes to remove barriers. (Somewhat different in different states)

  17. It Will Take Advocacy • With the exception of Medicare, healthcare is done state by state. • Tell us a story. • I have a story. • Make some friends. • AAFP • APA • NAMI • Who else?

  18. It May Take Struggle • John’s story of threatening litigation • Anyone else have a story?

  19. It Will Surely Take Information Sharing • Resources • What should we have? • Peer exchange • Web chat thread or backchannel Web chat thread or backchannel • Can we get an Editor?

  20. Who are our natural allies? • Disease focused groups that want best care. • Advocates for mental health access and parity • Mental health guilds who want opportunities • Enlightened physicians and physician groups who want to improve primary care • Enlightened health administrators (HRSA, VA) • Employers who want a better deal for their health dollar.

  21. What are we asking for? • That people would learn how important collaborative care can be in healthcare. • Adding in-practice behavioral health care to the definition of the medical home services • This may be more a task of exegesis than getting new text. • That they help us construct/target our message • That they would connect us to other interested folks • That they would do what they can to eliminate barriers (regulatory, financial, personnel, lack of information)

  22. Let’s get to work! • Get in a group and identify whom you think you might approach, and how. • Assemble the categories • Re-group by category and make a plan to keep in touch and report back. • Give the lists and the minutes to us. • Agree on information exchange format

  23. For further information: www.CFHA.net www.IntegratedPrimaryCare.com Blounta@ummhc.org

More Related