Terry McGeeney, MD MBA, President, CEO of TransforMED

Transcription

1 Terry McGeeney, MD MBA, President, CEO of TransforMED

2 Terry McGeeney, MD MBA, President, CEO of TransforMED

3 According to the Future of Family Medicine Report: unless there are changes in the broader healthcare system stem and within the specialty, the position of family medicine in the United States may be untenable in a year timeframe, which would be detrimental to the health of the American public.

4 Income Disparity affects Choice True in 1989, true now Is that a surprise? M. H. Ebell. Future Salary and US Residency Fill Rate RevisitedJAMA. 2008;300

5 only two percent of graduating medical students say they were considering practicing as primary- care physicians i

6 The Patient Centered Medical Home creates a framework for change The Patient Centered Medical Home creates a common language for change The Patient t Centered Medical Home creates an opportunity for change

7 Improved Outcomes! a. Quality b. Chronic Disease c. Satisfaction d. Efficiency (cost savings) e. Practice Financials

8 Number of uninsured and underinsured patients Highest Cost of Care in the world Second lowest quality in the world Current system is growing at a rate that is not sustainable Loss of Primary Care The Collapse of Healthcare (Health Insurance) reform has created an opportunity

9 Patient Centered Medical Home is not just about more new money for Primary Care It is not about just doing a better job of chronic disease management It is about the survival of Primary Care It is about redefining and redesigning Primary Care and the US Healthcare system

10 Access to Care & Information Health care for all Same-day appointments After-hours access coverage Accessible patient and lab information Online patient services Electronic visits Group visits Practice Management Disciplined financial management Cost-Benefit decision-making Revenue enhancement Optimized coding & billing Personnel/HR management Facilities management Optimized office design/redesign Change management Practice-Based Services Comprehensive care for both acute and chronic conditions Prevention screening and services Surgical procedures Ancillary therapeutic & support services Ancillary diagnostic services Health Information Technology Electronic medical record Electronic orders and reporting Electronic prescribing Evidence-based decision support Population management registry Practice Web site Patient portal Care Management Population management Wellness promotion Disease prevention Chronic disease management Patient engagement and education Leverages automated t technologies Quality and Safety Evidence-based best practices Medication management Patient satisfaction feedback Clinical outcomes analysis Quality improvement Risk management Regulatory compliance Care Coordination Community-based services Collaborative relationships Emergency room Hospital care Behavioral health care Maternity care Specialist care Pharmacy Physical Therapy Case Management Care transition Practice-Based Care Team Provider leadership Shared mission and vision Effective communication Task designation by skill set Nurse Practitioner / Physician Assistant Patient participation Family involvement options

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13 Access to Care and information Practice Level Services Care Management Continuity it of Care Services Practice Based Team Care Quality and Safety Health Information Technology Practice Management Patients

14 Advanced Access Scheduling is poorly understood & implemented: Blocks in schedule Capacity and demand Backlog Implementation strategy Extended hours remain a challenge

15 Physicians have lost skills surgical and diagnostic ROI not done for decision on ancillary services Capacity not developed for acute and chronic care

16 Wagner Chronic Care model poorly understood Office processes lacking to implement chronic disease management The issue for physicians is not knowing what to do Registries are poorly understood and utlized Population based registries work and are a critical success factor for chronic disease management and patient centered care Care Management vs Case Management Dedicated care manager in practice vs off-site/shared care manager

17 Practices consistently feel that care is well coordinated but process to accomplish that were generally lacking Focus on community resources outside of the practice was generally lacking All members of the patient s care team were not recognized

18 Primary Care physicians have a difficult time embracing the team concept Team based care is a critical component of chronic disease management Team concepts really do work and lead to higher quality, greater productivity and improved job satisfaction by providers and staff Everyone in the office must be considered part of the team

19 Most practices think they are providing quality care but most are not Safety at the practice level is inadequate Quality outcome metrics modify behavior

20 The biggest concern about technology implementation is operational not cost Point of care evidence based reminders improve quality and provider satisfaction The critical success factors for EMR implementation are change management and planning. It does not have to be traumatic tau atc

21 Typical business principles are lacking Primary Care practices are often not managed as the complex, high margin, complex businesses that they are A primary care practice is not economically viable at 2.4 patients per hour (AAFP data) Eliminating the operational inefficiencies in a practice translates t into revenue Practicing good evidence based medicine generates revenue and revenue from Pay for Performance Programs Midlevel providers are poorly utilized in practices

22 E-visits not well accepted by patients Access and cost are of primary importance to patients they assume quality; EMR and efficiency are back hall issues. Practice Web sites are popular with practices and patients E-visits work but patients need to be better educated and incentives need to change for patients t and providers Patients and providers like group visits

23 The entire model of care can be implemented The components of the model are interdependent Doing things does not create a patient centered environment and may actually do harm to the practice

24 Teamwork Change Management Leadership Communication

25 Practices not skilled in teamwork create a lot of dysfunction.

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27 Primary care practices are not prepared to change Primary Pi care practices are not motivated t to change Primary care practices are woefully uninformed about change Implementing change without addressing the issues around change can harm the practice

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30 Leadership at all levels within the practice is often lacking particularly around transformation ti

31 Communication within a practice is a major limiting factor for success

32 Communication formula: n(n-1) 2 2 people, 1 communication channel 4 people, 6 communication channels 12 people, 66 channels 15 people p 105 channels

33 CMS National Demonstration Project, Medicare Advantage Payers Employers State t Medicaid id Large Groups/IPA S/Hospital Systems ******Chronic Disease Management and P4P Pilots are not PCMH Pilots*****

34 The next step after the NDP Testing of payment methadologies Documentation of efficiency Documentation of improved outcomes based on practice dt data When have there been enough pilots and it is time to make real change?

35 Pilot Payment Methods Global Payments Shared Savings ----Accountable Care

36 Enhanced FFS (Fee for Service) Enhanced FFS +P4P (outcomes based) Enhanced FFS + Care Management Fee (CMF) Enhanced FFS + CMF + incentives (outcomes = quality and efficiency (cost savings) and PCMH recognition) CMF (care management fee)+ incentives CMF + incentives + grants CMF + incentives + shared savings Capitation, no-risk + incentives Capitation, no risk with FFS carve outs for procedures and dincentives

37 Hospitals might control total revenue from admission based on diagnosis based on Diagnosis DRG to include physician component Focus on networks and integrated systems by the government Hospital Systems are becoming active in PCMH discussions

38 Downward pressure on hospital days Concept is too share savings from reduced hospital days and other costs with referring physicians Opportunity for hospital at home concept Component of CMS pilot and some Medicare advantage projects Accountable Care

39 Terry McGeeney, MD MBA, President, CEO of TransforMED

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42 Blurred identity Political issues Patient acceptance and understanding Physician understanding Over-sold/Over-Hyped Lack of metrics of success has to be more than about money

43 Chronic Disease Management Pay for Performance Health Information Technology Partial PCMH Practice Centric not Patient Centric Payer is the winner not the patient

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46 Comprehensive Care Whole person orientation The pie is not going to get any bigger Primary Care workforce/compensation issues Perception of Specialists vs Primary Care

47 Patients have never liked the term Lack of understanding Perceived similarity to managed care Patients have not been adequately represented in the national discussion

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50 No Clear PCMH Definition No accurate PCMH standards No complete way to measure medical homeness The latest latest and greatest, best thing since sliced bread

51 Has to be about more than money Have to be based on complete medical homes partial medical homes lead to partial or no success Outcomes