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Med Home Port: Way ForwardSG Conference

January 21, 2011

RADM Karen Flaherty, Deputy Surgeon GeneralRADM Donald Gintzig, Deputy Chief, Medical Operations,

M3/5

RADM Matthew Nathan, Regional Commander, NCA

RADM Alton Stocks, Regional Commander, NME

RDML Forrest Faison, III, Regional Commander, NMW

RDML Eleanor Valentin, Regional Commander, NMSC

CAPT Maureen Padden

FORCM Laura Martinez

History of PCMH

• First coined by AAP in 1967 as central record• 2002: AAP expanded the concept• 2004: AAFP Future of Family Medicine project• 2005: IBM began to question healthcare costs• 2006: ACP Primary Care Medical Home Report• 2006: Joint Principles of the PCMH published by

AAFP, AAP and ACP• 2006: Creation of the Patient Centered Primary

Care Collaborative (PCPCC)

PCMH Strategy

• Improve physician / patient relationship• Improve access, quality, control cost of care • Increased costs and poorer health outcomes when

compared to other developing countries– U.S. ranks # 37 in quality but #1 in per capita costs

• High utilization of technology/procedures in US:– Drives misperception that healthcare is too expensive– Overuse exposes patients to potential adverse events

and errors

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Outcomes of Implementing Patient-Centered Medical Home Interventions: A Review of the

Evidence From Prospective Evaluation Studies in the United States

Updated November 16, 2010Kevin Grumbach, MD, Paul Grundy, MD, MPH

Group Health, Geisenger, VA, Blue Cross Blue Shield, Medicaid (NC, CO) and others… – Decreased PMPM– Decreased ER utilization– Decreased admissions– Improved quality metrics– Improved customer satisfaction (patients/staff)

Why Medical Home?

• Crisis in patient satisfaction in MHS vs. network• Improve upon the great care we already provide• Mandate from higher echelons to improve the

efficiency of Navy/Military Medicine• Unsustainable inflationary costs of medicine• “Medical Home is a game changer” (SG)

– Is different in many ways from what we do now…..– Team based, comprehensive care– True population based health management– Cost control, not cost savings

Why Medical Home?

Challenges in Execution

• PMO will provide the necessary subject matter expertise to assist MTF’s

• We will support leadership at every level with change management guidance

• Financial landscape presents challenges to be overcome by analysis, creativity, collaboration

• Practice roles will be transformed in powerful ways; opportunities for health care team

• We will ultimately alter what we recognize and reward; pilots present a hybrid model for the future

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Short Term Goals

• Innovation and creativity; transformation• Self reflection on current practices and “why?”• Recognition that the status quo must be changed• Accountable teams focused on patient centered

access and continuity• Enhance patient and staff satisfaction• Improve prevention and readiness• Decrease ER / Urgent Care use • Reduce unnecessary specialty care use

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Long Term Goals

• Improve overall health and quality of care• Reduce unnecessary hospitalization• Recapture network enrollment when possible• Recapture high value network specialty care• Civilian experience suggests we could

– Control (bend) the cost curve within a couple of years– Reduce inflation of Per Member Per Month (PMPM)

• May be some upfront investment to see returns– NC Medicaid project– Healthier population greater expense long term

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Experience of Care MHP Team Continuity PCM Continuity 3rd Next Available Acute 3rd Next Available

Routine Patient Satisfaction Staff Satisfaction

Population Health Diabetes Asthma Colon cancer Breast cancer Cervical cancer

Per Capita Cost PMPM (Clinic/Team) ER Utilization Urgent Care Utilization Specialty Care Utilization Enrollment / FTE

Readiness Indeterminate Fully Medically Ready

MHP Strategic Dashboard

MHP PMO Way Forward

• BUMED strategic communication plan to ensure consistent messaging regarding MHP

• PMO Implementation Team expanding• Formalized training and execution plan for MHP• Med Home Port dashboard on MHS Insight• Roll out Care Point and Secure messaging• NCQA recognition:

– Baseline self assessments– Collaborative journey through formal recognition

Why Medical Home?

Med Home Port Logo

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“If you don't like change, you're going to like irrelevance

even less."

General Eric Shinseki (ret), Former Chief of Staff, U.S. ArmySecretary of the Veteran’s Administration

More Information on PCMH

• Session at MHS Conference on PCMH– Several tracks worth attending– In particular:

• PCMH in the services (Track H)• Access to Care (Track H)• Enrollment (Track H)• Population Health Management (Track H)• Cultural Change in PCMH (Track H)• Financial incentives in PCMH (Track K)

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Panel Discussion

RADM Karen Flaherty, Deputy Surgeon GeneralRADM Donald Gintzig, Deputy Chief, Medical

Operations, M3/5

RADM Matthew Nathan, Regional Commander, NCA

RADM Alton Stocks, Regional Commander, NME

RDML Forrest Faison, III, Regional Commander, NMW

RDML Eleanor Valentin, Regional Commander, NMSC

CAPT Maureen Padden

FORCM Laura Martinez / HM2 Swindle

Small Group Work

• Each table has been assigned two distinct questions regarding implementation of MHP

• 30 minute table discussion• Capture key issues, potential solutions• Prioritize top three recommendations• All tables will be asked to record recommendations• Several tables will be asked to report out