The Patient-Centered Medical Home & Health 2.0 AHRQ Annual Conference September 15, 2009 Michael S. Barr, MD, MBA, FACP Vice President, Practice Advocacy.

The Patient-Centered Medical Home

& Health 2.0

AHRQ Annual ConferenceSeptember 15, 2009

Michael S. Barr, MD, MBA, FACPVice President, Practice Advocacy & Improvement

Division of Governmental Affairs & Public Policy202-261-4531

[email protected]

IOM Definition of Patient-Centered Care

Healthcare that establishes a partnership among practitioners, patients, and their families (when appropriate) to ensure that decisions respect patients’ wants, needs, and preferences and that patients have the education and support they need to make decisions and participate in their own care.

Envisioning the National Healthcare Quality Report, 2001. Institute of Medicine, National Academy PressAccessed at: http://books.nap.edu/openbook.php?record_id=10073&page=41

Sarasohn-Kahn, J: The Wisdom of Patients: Health Care Meets Online Social Mediia, CHCF April 2009

Health 2.0 Definition

“The use of social software and its ability to promote collaboration between patients, their caregivers, medical professionals, and other stakeholders in health.

What is Patient-Centered Care?

• One of IOM’s six domains of quality • Picker Institute – 8 dimensions of care • “Nothing about me without me”• The right care in the right way at the right time• Providing the care that the patient needs in

the manner the patient desires at the time the patient desires

Shaller, D. Patient-Centered Care: What Does It Take?http://www.pickerinstitute.org/documents/PI%20Shaller%20Final%20Report.pdf

What is the Patient-Centered Medical Home?

• …a vision of health care as it should be• …a framework for organizing systems of

care at both the micro (practice) and macro (society) level

• …a model to test, improve, and validate• …part of the health care reform agenda

“PCMH” is a Term…

• …to describe a pathway to excellent health care• …to re-claim a role as advocates for our patients

(with our patients & their families)• …to encourage team-based care• …to create educational opportunities• …to attract medical students and residents to

primary care

The Joint Principles of the PCMH• Personal physician • Physician directed medical practice• Whole person orientation • Care is coordinated

and/or integrated• Quality and safety• Enhanced access to care • Payment to support the PCMH

Team-based care: Patient/FamilyNP/PARN/LPNMedical AssistantOffice StaffCare CoordinatorNutritionist/EducatorPharmacistBehavioral HealthCase ManagerSocial WorkerCommunity resourcesDM companiesOthers…

Patient-Centered, Physician-Guided Care

Adapted from:Defining Primary Care: An Interim Report, Institute of Medicine 1994

Physician Patient

Practice Family Team

Adapted from:Defining Primary Care: An Interim Report, Institute of Medicine 1994

Physician Patient

Practice Family Team

Core of Team-Based Care

Health 2.0 – Who is Using the Internet?

• 74% of Americans go online• 61% of adults look online for health information• For health/medical issues:

– 86% of all adults ask a health professional– 68% of all adults ask a friend or family member– 57% of all adults use the internet– 54% use books or other printed reference material

Source: Pew Internet & American Life Projecthttp://www.pewinterent.org/reports/2009/8-The-Social-Life-of-Health-Information.aspx

Health 2.0 – Impact on Decisions/Actions

• Of the 60% who use online health information (e-patients):– 60% say the information affected a decision about

how to treat an illness or condition– 53% say it led them to ask their physician new

questions or to get a second opinion– 49% say it changed the way they think about diet,

exercise, or stress management– 60% say they or someone they know has been helped

Source: Pew Internet & American Life Projecthttp://www.pewinterent.org/reports/2009/8-The-Social-Life-of-Health-Information.aspx

The New PCMH Team?

Practice Implications

• Challenges of transformation• Initial capital and restructuring costs• Ongoing support & maintenance• Reporting on quality, cost and satisfaction • Implementation of HIT coincident with PCMH• Cultural change• Information overload• Shift/sharing of “power”

A Commitment to Excellence• Patient-centered communication• Shared decision making• Timely access to care • Transparency & accountability• Electronic health records• Use of comparative effectiveness research &

evidence-based guidelines• Safety• Measure, improve, measure