patient centered medical home. something has got to give……health costs a factor in us...
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Patient Centered Medical Home
Something has got to give……health costsa factor in US Competitiveness
While others struggle to reform health While others struggle to reform health care, we can’t wait – Oklahoma is moving care, we can’t wait – Oklahoma is moving ahead and transforming now….ahead and transforming now….
800
850
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1,000
1,050
1980 1985 1990 1995 2000 2005
Tulsa
US
Over past 25 years, only Over past 25 years, only State with worsening State with worsening Age-adjusted Death RatesAge-adjusted Death Rates
Death RateDeath Rate
USUS
Tulsa and Tulsa and OklahomaOklahoma
Oklahoma:Oklahoma: Last in the US in health system performance. Only state with worsening death rate. Last in US in physicians per capita. Tulsa - 14 year difference in life expectancy. Upper quarter of health care spending. Innovative health system and insurance expansions.
OU School of Community Medicine:OU School of Community Medicine: Nation’s first School of Community Medicine Serves as the region’s platform for change Goal – Improve health of entire communities;1. Recruit for and maintain altruism – MDs, PAs, Nurse
Practitioners – using clinical experiences, scholarship and loan payback efforts to motivate.
2. Curriculum – add public health, systems engineering, student run clinical services.
3. Expansive network of innovative primary care, specialty care programs out in neighborhoods most in need - e.g. 19 school based clinics.
4. Patient Centered Medical Home – for uninsured and Medicaid populations implemented.
5. Partners with OU social work, early childhood education, school systems, urban planners etc.
6. Health Information Technologies – patient to doctor, doctor to doctor: reduced need for face to face visits by 52%. Consortia in place for Health Information Exchange and Health Information Coordination.
14 year difference14 year differenceIn life expectancy In life expectancy between North andbetween North andSouth TulsaSouth Tulsa
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
Patients’ chief complaints or reasons for visit determines care
We systematically assess all our patients’ health needs to plan care
Care is determined by today’s problem and time available today
Care is determined by a proactive plan to meet patient needs without visits
Care varies by scheduled time and 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
I know I deliver high quality care because I’m well trained
We measure our quality and make rapid changes to improve it
It’s up to the patient to tell us what happened to them
We track tests & consultations, and follow-up after ED & hospital
Clinic operations center on meeting the doctor’s needs
A multidisciplinary team works at the top of our licenses to serve patients
Acute care is delivered in the next available appointment and walk-ins
Acute care is delivered by open access and non-visit contacts
Pharmacy & Health Foods
Pharmacy & Health Foods
Urgent Care
Services
Urgent Care
Services
Specialty Dx/Rx
Services
Specialty Dx/Rx
Services
Surgical & Intensive Services
Surgical & Intensive Services
Chronic Disease Service
Chronic Disease Service
Wellness & Fitness Clubs
Wellness & Fitness Clubs
HEALTH CARE
SYSTEM
HEALTH CARE
SYSTEM
Diagnostic Testing & Imaging
Diagnostic Testing & Imaging
Primary Care
Services
Primary Care
Services
Medical Care 2000
Pharmacy & Health Foods
Pharmacy & Health Foods
Urgent Care
Services
Urgent Care
Services
Specialty Dx/Rx
Services
Specialty Dx/Rx
Services
Surgical & Intensive Services
Surgical & Intensive Services
Chronic Disease Service
Chronic Disease Service
Wellness & Fitness Clubs
Wellness & Fitness Clubs
HEALTH CARE
SYSTEM
HEALTH CARE
SYSTEM
Diagnostic Testing & Imaging
Diagnostic Testing & Imaging
Primary Care
Services
Primary Care
Services
Medical Homes 2009
Patient-Centered
Medical Home:
Patient-Centered
Medical Home:
Pharmacy & Health Foods
Pharmacy & Health Foods
Urgent Care
Services
Urgent Care
Services
Specialty Dx/Rx
Services
Specialty Dx/Rx
Services
Surgical & Intensive Services
Surgical & Intensive Services
Chronic Disease Service
Chronic Disease Service
Wellness & Fitness Clubs
Wellness & Fitness Clubs
HEALTH CARE
SYSTEM
HEALTH CARE
SYSTEM
Diagnostic Testing & Imaging
Diagnostic Testing & Imaging
Primary Care
Services
Primary Care
Services
Health Information Exchange 2010
Patient-Centered Medical Home:
Wellness Evaluation & Plan
Patient-Centered Medical Home:
Wellness Evaluation & Plan
EMR & HIE
Web-based Communication Portals
Decision Support
EMR & HIE
Web-based Communication Portals
Decision Support
Pharmacy & Health Foods
Pharmacy & Health Foods
Urgent Care
Services
Urgent Care
Services
Specialty Dx/Rx
Services
Specialty Dx/Rx
Services
Surgical & Intensive Services
Surgical & Intensive Services
Chronic Disease Service
Chronic Disease Service
Wellness & Fitness Clubs
Wellness & Fitness Clubs
HEALTH CARE
SYSTEM
HEALTH CARE
SYSTEM
Diagnostic Testing & Imaging
Diagnostic Testing & Imaging
Advanced Medical Home 2011
EMR & HIE
Web-based Communication Portals
Decision Support
EMR & HIE
Web-based Communication Portals
Decision Support
Team Based - Primary Care
Health Information Integration / Coordination
Team Based - Primary Care
Health Information Integration / Coordination
Lessons: Medical Home Teamwork• New roles and responsibilities
– Everyone functions at the top of their license– New teamwork roles for students and residents
• New work flow– Team meetings for planning and improvement – Continuous training, learning, and improvement– Non-visit “touches” deliver pro-active, planned,
coordinated, and integrated care– Data driven work – not visit driven work
• New Approach to quality and safety– Eliminate re-work– Eliminate duplicated effort– Eliminate work-a-rounds
Registration, MH assignment, billing, contracting, compliance with contract
Access to appointments, non-visit advice and help
Clinical Preventive services
Acute Care, ER and UCC Management
Patient Activation & Behavior Change
Social & Mental Health Services
Medication Monitoring
DX & RX Mgt.
Specialists
HRCM
Medical Home Multidisciplinary Team
0% 25% 50% 75% 100%
Clerical
Nursing
Physician, PA, NP
Social Work
Pharmacy & Nursing
2,000 People Assigned to a Medical Home
Lessons: Project Management as the Lessons: Project Management as the Implementation StrategyImplementation Strategy
PCMH-OHCA Dashboard 3/13/09
0 5 10 15 20 25 30 35
1
2
3
TIE
R
OHCA Required Elements
YES SOME NO
70% 30%
50% 44% 6%
35% 48% 17%
Our Organization’s Enthusiasm Levels: Our Organization’s Enthusiasm Levels: A Project LifecycleA Project Lifecycle
Sept ‘08 Mar ‘09
Pla
nnin
g
Announcement
Implem
entation
CultureCrisis
Succe
ssfu
l
Progr
ess/
Proje
cts
EN
ER
GY
/ S
UP
PO
RT
TIMELINE
Getting Organized - “Tulsa Health” (black = established, blue = in development or proposed)
Acute – Walk In Care:• OU Bedlam Evening Clinics• OU Bedlam Evening Pharmacy• OU Bedlam Evening Clinics Case Management and Referral Programs• Good Samaritan Clinics
Safety Net Clinics
Emergency Rooms:• Saint Francis Hospital • St. John Medical Center• Hillcrest Medical Center• OSU Medical Center
ER Diversion Programs:• OU Tisdale Health Center Urgent Care Clinic• OU ER Diversion and Follow Up Clinic• OSU / St. John Program
Prevention Initiatives
Front Doors to Care
• 211 Line• Baby Line• OU Nursing Prenatal Care• Harvard Project - Cycle of Poverty• PENN Project – Anchor Community Schools
INSURE
OKLAHOMA--MEDICAID
Primary Care Clinics and Medical Homes
• OU Bedlam Longitudinal Clinic – PCMH Model 6 sessions / week• OU School-based Clinic = 19 sites – PCMH Model• OU Housing Authority Clinics = 2 – PCMH Model• OU Micro-clinics – Day Center for the Homeless – 5 days per week Neighbor for Neighbor, Neighbors Along the Line,• OU Physicians Clinics – Hillcrest – PCMH Schusterman Center - PCMH• OSU Physicians Clinics – SW Boulevard, Houston Park• OSU Physicians – Country Club Gardens• Morton Clinics – FQHC – Lansing Park, East Tulsa• Community Health Connections – FQHC - East Tulsa, 3rd and Lewis.• Patient Centered Medical Home Patient Portal with IBM• Greater Tulsa Health Access Network – Greater THAN – Health Information Exchange and Care Coordination
Specialty Care
• MAP / Voucher Specialty Care Network• Northland Imaging Center • OU Physicians Clinics at St. John, Saint Francis and Hillcrest Medical Centers, • OU Schusterman Center Clinics• OSU Physicians Clinics at OSU MC, Houston Park, SW Boulevard• OU OB Outreach – e.g. Margaret Hudson. Porter, Community Health Connections• OU Xavier Breast Health Clinic• OU Bedlam Specialty Clinics – Derm, HIV, Gynecology, Hep C • Heart Intervention Project• OU Diabetes Center• OU Cancer Institute• OU Tisdale Specialty Health Center• Doc 2 Doc e-consultations between primary care and specialists
Intensive Outpatient Programs
• PACT Teams – Severe mental illness• COPES Team – Emergency Psychiatry• ER Frequent Flyer Team – Multiple medical illnesses
Pharmacy Services
• Tulsa County Pharmacy• OU STEP Pharmacy• OU Bedlam Pharmacist Program and 5 community pharmacies
Clancy 8 / 2009