Primary Care & New Jersey

1. Primary Care & New Jersey James E. Barr, MD Medical/Executive Director, Central Jersey Physician Network IPA Horizon BCBS of NJ HMO Board Member Member, Patient-Centered Primary Care Collaborative Partner/Owner, Pleasant Run Family Physicians, Flemington, NJ A Level III Patient-Centered Medical Home

2. Payment for added value Personal physician Physician-directed practice Quality and safety Enhanced access Whole-person orientation Coordinated care - part 1 Coordinated care – part 2 Joint Principles of the PCMH

3. 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 Patient’s reason for visit determines care We systematically assess all our patients’ health needs to plan care Care is reactive to the patient’s problem and visit time available Care is proactive to meet patient needs with or without visits Care varies by 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 Slide adapted from Daniel Duffy MD School of Community Medicine Tulsa Oklahoma

4. MEDICAL HOME CARE TODAY’S 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 A multidisciplinary team works at the top of our licenses to serve patients Clinic operations center on meeting the doctor’s needs Slide adapted from Daniel Duffy MD School of Community Medicine Tulsa Oklahoma

5. Access and Communication Patient Tracking and Registry Functions Care Management Patient Self-Management Support E-Prescribing 2-6 Elements per Standard 3 Levels of Certification Test Tracking Referral Tracking Performance Reporting and Improvement Advanced Electronic Communications Standards are inclusive of “Must Pass Elements” NCQA PPC-PCMH Recognition Program: 9 Standards

6. Performance & Transparency

7. PCMH Compensation Model: supports practice transformation, care coordination, and value Blended Payment Methodology Pay For Results Prospective Payment FFS For services currently recognized through Medicare RBRVS system; or additional services NCQA Criteria for Medical Home Process Redesign HIT Evaluate Levels of Achievement Clinical Process and Outcomes Resource Use Costs of Care Experience Of Care Pre-Assessment of Practice Readiness Support from ACP, AAFP, AOA, AAP, Blue Plans, Employers, Consumer Advocates

8. PCMH Model Experiences • Geisenger Health Plan: 14% reduction in hospital admissions relative to controls, 9% reduction in overall costs • Group Health Cooperative: 25% reduction in diabetic costs related to specialists and hospital admissions, 11% reduction in overall costs • Johns Hopkins: 15% decrease in ER visits, 24% reduction in hospital inpatient days, annual $1,362 net Medicare savings per patient • North Dakota Blues: Diabetics 4:1 ROI • Community Care North Carolina: $225 million savings • Health Partners:39% decrease in ER visits, 24% decrease in hospital admissions, 8% reduction in overall costs • Intermountain Healthcare: 10% reduction in hospital admissions, net reduction in total costs $640 per patient per year

9. For More Information Patient-Centered Primary Care Collaborative – www.pcpcc.net Bridges to Excellence – Medical Home Recognition Program www.bridgestoexcellence.org NCQA Physician Practice Connections Patient-Centered Medical Home www.ncqa.org www.medicalhomeinfo.org Jim Barr, MD JBarr5@aol.com CJPN Office 908-788-0325 Cell 908-337-3483 Multicultural Healthcare Communications, Arnold Joseph, 917-887-3405