The Patient Centered Medical Home what about the

The Patient Centered Medical Home – what about the patient? Family Medicine Leaders in Large Multispecialty Groups Scott & White/Texas A&M meeting Dallas, TX September 8, 2012 John Messmer, M. D. Associate Vice-Chair for Inpatient Medicine Medical Director, Penn State Hershey Medical Group, Palmyra Family & Community Medicine Penn State Hershey Medical Center

PCMH – what about the patient? PCMH characteristics*: Personal physician Physician Directed Whole person Coordinated care Quality and Safety Enhanced access Payment for advanced access *AAFP, AAP, ACP, AOA

PCMH – what about the patient? Consumer engagement—…the PCMH should seek to engage, involve, integrate and partner with consumers (patients and families). All activities should take a perspective of working with consumers to envision, build and enable successful PCMHs. Patient Centered Primary Care Collaborative. A Collaborative Partnership: Consumer Guidelines 2009.

PCMH – what about the patient? Community—PCMH implementation should be community-based, given that the majority of health care is local. Communities and consumers are diverse and a one-sizefits-all approach will likely fail.

PCMH – what about the patient? Grassroots—The PCMH approach and defined need must come from the bottom up.

PCMH – what about the patient? Communication—A long-recognized barrier to patient centered care is the inherent limitation in the ability of members of the care team to adequately communicate, translate and educate consumers/patients about complex health care topics. Communication barriers include language, literacy, culture, age and income. It is through communication and translation that relationships are based.

PCMH – what about the patient? Think broadly—Consider the needs of all stakeholders and how diverse needs will be accommodated through the PCMH… Community resources that go beyond health care, but critically impact health (e. g. , food, housing, social work), particularly for the elderly…

PCMH – what about the patient? What do patients want in a PCMH? Jaen, CR, et al. Patient Outcomes at 26 months in the patient-centered medical home national demonstration project. Ann. Fam. Med 2010; 8: S 57 S 67. Patient experience worsened! Campbell, SM, et al. Changes in patient experiences of primary care during health service reforms in England between 2003 and 2007. Ann. Fam. Med 2010; 8(6): 499 -506. Lowered patient satisfaction; harder to obtain care. Reid, RJ, et al. The Group Health medical home at year two: cost savings, higher patient satisfaction, and less burnout for providers. Health Affairs 2010; 29(5): 835 -843. Improved patient satisfaction.

PCMH – what about the patient? What do patients really want In the PCMH? Have we asked them? “…ideally, one would obtain patients’ perspectives. ” Audet, A, et al. Adoption of patient-centered practices by physicians. Arch Int Med 2006; 166(7): 754 -759. Access* to the same doctor? *not difficult to contact; not difficult to get care after hours; office always organized and on time. Beal AC, et al. Closing the divide: how medical homes promote equity in health care. The Commonwealth Fund. http: //www. commonwealthfund. org/usr_doc/1035_Beal_closing_divide_medical_ho mes. pdf? section=4039 (accessed 19 Aug 2012) Or what?

PCMH – what about the patient? What was built:

PCMH – what about the patient? What they wanted:

PCMH – what about the patient? The Medical Home – the patient’s role from the physician’s perspective Participation Understand wellness goals & comprehensive/coordinated care Active engagement - making an effort +/- professional support Education Understand the issues, meds, tests; info access Decision Preferences re: treatment, preventive vs Rx, end-of-life Trust Information source Critique Feedback and support

PCMH – what about the patient? Our role: Access★★★ Comprehensive care Population management Team based care Care coordination & management Evidence based care Management support What about the Disney factor?

PCMH – what about the patient? The Disney factor “What time is the 3 o’clock parade? ”

PCMH – what about the patient? How does Disney apply to the PCMH? Ø Service – attitude, access, fulfill needs Ø Support – information, results, etc. Ø Access – your schedule or theirs? Ø Empathy – WWWDD? Ø Ø Ø 4: 00 call for “something for a headache” Non-adherence Return calls In other words: “a relationship” They don’t call it “Patient-Centered” for nothing.

PCMH – what about the patient? How do we do that? Patient

PCMH – what about the patient? Usage license purchased.

PCMH – what about the patient? What will it take? Changes in: - practice patterns - control - payment systems - patient expectations - providers’ ideas of care

PCMH – what about the patient? Questions? ?