THE COMMONWEALTH FUND The Patient-Centered Medical Home Strategy

THE COMMONWEALTH FUND The Patient-Centered Medical Home: Strategy to Improve Health System Performance Melinda Abrams, MS The Commonwealth Fund Alliance for Health Reform Briefing September 22, 2008

Primary Care Score vs. Health Care Expenditures, 1997 UK DK NTH SP FIN AUS SWE CAN JAP GER BEL US FR Starfield 10/00 00 -133 Starfield 10/00 IC 1731 THE COMMONWEALTH FUND

What is a Medical Home? • “A medical home is not a building, house, or hospital, but rather an approach to providing comprehensive primary care. . . A medical home is defined as primary care that is accessible, continuous, comprehensive, family centered, coordinated, compassionate, and culturally effective. ” – American Academy of Pediatrics 2020 Vision Accessible Patient Centered Coordinated Care THE COMMONWEALTH FUND

The Patient-Centered Medical Home: Principles of Four Primary Care Specialty Societies • Personal Physician • Whole person orientation • Coordinated and integrated care • Safe and high-quality care (e. g. , evidenced-based medicine, appropriate use of HIT, continuous QI) • Enhanced access to care • Payment that recognizes the added value provided to patients who have a patient-centered medical home *** A Systems Approach: Access, Quality and Efficiency THE COMMONWEALTH FUND ACP, AAFP, AAP and AOA. Joint Principals of the Patient-Centered Medical Home, March 2007.

Six Attributes of High Performance Health Care Delivery System 1. Patients' clinical information is available to all providers at the point of care and to patients through electronic systems. 2. Patient care is coordinated among multiple providers, and transitions across care settings are actively managed. 3. Providers (including nurses and other members of care teams) both within and across settings have accountability to each other, review each other's work, and collaborate to reliably deliver highquality, high-value care. 4. Patients have easy access to appropriate care and information including after hours; there are multiple points of entry to the system; and providers are culturally competent and responsive to patients' needs. 5. There is clear accountability for the total care of patients. 6. The system is continuously innovating and learning in order to improve the quality, value, and patients' experiences of health care delivery. THE COMMONWEALTH FUND

Outcome measures; large % of total payment Full Population Prepayment Global Case Rates Less Feasible Care coordination and intermediate outcome measures; moderate % of total payment More Feasible Medical Home payments Fee-for. Service Small practices; unrelated hospitals Independent Practice Associations; Physician Hospital Organizations Simple process and structure measures; small % of total payment Fully integrated delivery system Continuum of Organization Source: The Commonwealth Fund, 2008 Continuum of P 4 P Design Continuum of Payment Bundling Organization and Payment Methods THE COMMONWEALTH FUND

Acknowledgements Rachel Nuzum, Senior Policy Director, The Commonwealth Fund Elizabeth Hodgman, Program Associate, Patient-Centered Primary Care Initiative Visit the Fund at: www. commonwealthfund. org THE COMMONWEALTH FUND