Patient Centered Medical Home Model Solution to Diabetes Disparities?
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- Rodger Chambers
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1 Patient Centered Medical Home Model Solution to Diabetes Disparities? Women In Government Second Annual Diabetes Task Force Kenyatta Lee, MD Clinical Director, Community Clinics Department University of Florida/Shands Jacksonville
2 PCMH Will Revitalize Primary Care It provides a Vision for the future practice of primary care medicine. It is a Guide for office redesign that promises better results for patients and for physicians. It provides a path to fortify primary care and establish its value in our health system.
3 History of the Medical Home First introduced by pediatricians for special needs children in 1967 IOM advocated for medical homes in 1996 Future of Family Medicine Project called for a personal medical home for all Americans in 2004 American College of Physicians called for advanced medical homes in 2006
4 The Patient-Centered Primary Care Collaborative Examples of Broad Stakeholder Support & Participation Providers ACP AAP AAFP AOA ABIM ACC ACOI AHI Payers The Patient-Centered Medical Home Purchasers IBM General Motors FedEx General Electric Pfizer Microsoft Business Coalitions Merck Patients BCBSA United CIGNA WellPoint Aetna Humana HCSC NCQA AFL-CIO National Partnership for Women and Families Foundation for Informed Decision Making SEIU
5 7 Core Features 1. A personal physician 2. Physician-directed medical practice 3. Whole person orientation 4. Coordinated care 5. Quality and safety 6. Enhanced access 7. Payment reform
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7 NCQA CERTIFICATION
8 MOUNTING EVIDENCE 2007 prospective cohort study of 756 patients with life-limiting illnesses in California In the patient-centered group: 38% fewer admissions 36% fewer inpatient days 30% fewer ED visits 26% lower cost Sweeney L, Halpert A, Waranoff J. Patient-Centered Management of Complex Patients Can Reduce Costs Without Shortening Life. Am J Manag Care. 2007;13:84-92.
9 MOUNTING EVIDENCE Study of North Carolina Medicaid claims for asthma in children , Fee for service vs Medical Homes Better use of asthma medications and fewer ED visits and hospital admissions Spending levels increased, but due to better provision of preventive services Domino ME, Humble C, Lawrence WW Jr, et al. Enhancing the medical homes model for children with asthma. Med Care. 2009;47(11):
10 MOUNTING EVIDENCE Geisinger Health System in Pennsylvania 36 primary care practices with NCQA Level 3 PCMH certification vs control practices Positive results: 40% reduction in 30-day readmissions 20% reduction in (total) admissions 7% lower costs Arvantes, J. Geisinger Health System Reports That PCMH Model Improves Quality, Lowers Costs. AAFP News Now. May 26, 2010.
11 What factors inspired us to function like a medical home?
12 Disparity Traditional Hybrid Soutel Wellness Gateway Durkeeville Shands Soutel College Park Commonwealth C.B. McIntosh Eastside Murray Hill Brentwood
13 JUDI Issues on the horizon that could have a devastating impact on the Urban Core P4P/VBP PQRI MRA Meaningful Use
14 Community Affairs Department Community Responsive Medicine Medical Director Vice President Consultant Clinical Programs JUDI Grant Writing Disease Mgmt Clinical Pharmacy J-HIT Psych Case Mgmt Communit y Programs Clinics D-RAP REACH Coumadin CHF/HRS A Access Portal Anxiety Social Worker Case Mgmt Disparity Hybrid Traditional HY-LIP HYLIP/HRS A Allscripts Durkeeville Brentwood Paxon P-DIP Pain IDX CHF Med Data Soutel Eastside Murray Hill CARE KIM Server Based Connectivit y C. B. McIntosh Wellness C. B. McIntosh Pediatric College Park Care Mgmt. Gateway Soutel
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16 Graph 1: Overall baseline characteristics of participants and data analysis by gender. Number of Participants 457; Males 157, Females - 300
17 Graph 2: Changes in Hemoglobin A1c by Clinic Location. Number of Participants 457; Brentwood 64, College Park 49, Commonwealth 50, Eastside 126, Murray Hill 141, Soutel 27
18 Graph 3: Race-related differences in Hemoglobin A1c levels. Number of Participants 457; African American 280, Caucasian 162, Other
19 FREE SCRIPTS Part of JUDI Disparity Clinic System: Removes barrier of Access to Medical Care Patient given generic or negotiated brand medications At No Cost Increases patient compliance Decreases ER and Hospital encounters
20 Free Script
21 Number of ER self-pay cases.
22 ER impact on an annual basis with an average cost per visit saved. Overall Number of Walk-ins by Clinic Cost Savings Eastside 5,003 $1,625, Brentwood 4,671 $1,709, Number of ER Follow-ups by Clinic Cost Savings Eastside 1,352 $439, Brentwood 552 $202, Number of Hospital Discharges by Clinic Cost Savings Eastside 442 $842, Brentwood 271 $516,255.00
23 Questions?
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