People actively working to transform health care delivery

 

Jeffrey Hanson, Thomson Reuters

Why are you involved in the PCPCC?

My personal interest is in the whole movement towards a patient centered health system. 

From a business perspective, I work for a large information company and information is going to be at the core of this.  It’s important to ensure the types of information for patients and doctors to use at the point of care are there in order to make better decisions .

You work in leadership for the Center for eHealth Information Adoption and Exchange.  How important is that center to the PCMH model?

I think the focus is currently lopsided.  The focus is really on the adoption of health IT, and I think nothing is really going to transform health care until the actual exchange of the information happens and people use it in the way it was meant to be used.  I think it will be very easy for the health care community at some level to adopt technology now that there’s funding out there for it.  But what’s important is how they use it and how they exchange it.

Why do you think the PCMH model is important from a policy standpoint?

Even for a consumer in a large metropolitan area like Boston, which is flooded with high-performing physicians of every type, I think from my perspective, to have a medical home where someone can go to and get answers is very valuable.  There is so much information out there right now that I think patients are paralyzed to do anything.  It gets even worse when the system they go into is so fragmented. So from a policy perspective, I think it’s extraordinarily important to pull that together and then to have a medical home where someone can go to find someone who will listen and help them get answers to the issues and health problems that they are facing.

 

Shari Erickson, MPH, American College of Physicians

Why is the PCMH important to you?

It’s a critical part of my job at the American College of Physicians.  We represent over 129,000 internal medicine physicians across the country, over half of which are involved in providing primary care.  They are currently trying to provide the best possible care for their patients in a system that incentivizes volume over quality and satisfaction.  The patient centered medical home model is one that we believe can contribute to improving this broken system for our members and their patients, so that they and other key stakeholders can obtain greater satisfaction and value from the system.  Therefore, I’m engaged in helping to move PCMH pilots along to test this concept in order to learn from it, develop it further, and determine how best to implement it on a broader scale.

On a personal level, I am also motivated by the experiences that my family and I have had within the current health care system, such as unnecessary or duplicate tests, poor handoffs during care transitions, and inadequate communication from and with the care team.  I hope that in some way the work we’re doing can improve it on the ground level for the people I and other consumers, patients, and caregivers care about.  

Why do you think the PCMH model is important from a policy standpoint?

I believe it’s important to improve access to care through coverage, but doing that alone isn’t enough.  We must have a system that works in order to handle the influx of previously uninsured individuals, as well as those that are already participants.  The PCMH is one approach that can contribute to improving the system through its focus on the partnerships of individual patients with their physicians and care teams, coordinated care that is integrated across settings, and optimal quality and safety.  Additionally, the PCMH model is one that can lead to greater satisfaction among primary care physician and their teams, which may contribute to efforts aimed at improving the dwindling pipeline of primary care providers.  Therefore, it is critical that the PCMH model be incorporated into the current health care reform efforts.

You are in leadership for the Center for Multi-Stakeholder Demonstrations.  Why is this Center’s work important to advancing the PCMH?

One primary roles that the Center can continue to take on is convening key stakeholders to share their achievements, barriers, and lessons learned in testing and implementing the PCMH model—and then to  compile and broadly disseminate these experiences and lessons.  While every PCMH pilot is unique in many ways, most of them come face-to-face with similar issues such as what evaluation methodology and measures to use, anti-trust issues, practice transformation approaches, payment methodologies, what technologies to employ, how to implement those technologies, etc.—and so sharing information across projects on a regular basis is extremely valuable and we will hope will help to get more pilots off the ground and rapidly facilitate the spread and broader implementation of the model as more and more positive results come in.

 

 

A. John Blair III, MD, President, Taconic IPA; CEO, MedAllies

 

Why are new models of care (such as the patient centered medical home) important?

The patient-centered medical home creates a new focus on more comprehensive, forward-looking patient care. The medical home model looks at the whole patient—not just as an acute episode in treating the current problem, which we do well—but the patient’s total needs for their ongoing health. It takes into account preventive care; it takes into consideration mental state. It’s more comprehensive: It looks at them in the context of their family and their community. It looks at their health and well-being. It’s more holistic.

 

It also engages the patient. It doesn’t say, “I am going to tell you what to do and you are going to listen.” It moves from that parent/infant relationship to a more collegial partnership.

 

It seeks to truly educate and explain to the patient what the provider believes is best. It lets the patient receive that, digest it, and then come back with what works for them.

 

It involves education, understanding and negotiation between the provider and the patient, which has the potential of achieving more, because the patient is part of that decision-making process.

 

If done well, it frees the provider to handle the things they are best trained to handle—the more complex, acute problems. It allows the team—the nurses, the physician extenders, the assistants—to work, under the doctor’s supervision, at the top of their licenses. It’s a much more effective use of skill sets. It more effectively distributes workload and tasks necessary to best care for the patient.

 

There’s also an awareness of coordination of care between the primary care physician and other sources of care–specialists, long-term care, etc. There’s an effort to create processes that increase awareness of care outside the primary care practice and then coordinate that care.

 

How is what the Hudson Valley doing important to the advance of these new models of care?

The Hudson Valley has come to terms with the stark reality of how difficult this really is. It has honestly embraced the concept not just in spirit, but also in practice.

 

It sounds great to talk about the patient-centered medical home, and it sounds great from a policy level; it’s a completely different thing to get down and do it. Hudson Valley has taken the theory and put it into practice—not shying away from obstacles, but cataloging those obstacles and coming up with ways to address them.

 

It doesn’t mean you get everything done that first week, that first year. It means you prioritize based on the most important or the most manageable, but you don’t erase the most difficult things from the list.

 

What the Hudson Valley has done is this: It understands the concepts and has explored the structural and process changes needed to address those concepts. It then established goals around those concepts and then figured out, between financial and human resources, how to accomplish those goals. And it’s beginning to do that. The process is not complete yet, but the evidence indicates that we are meeting those goals.

 

The Hudson Valley is also taking an honest look at what’s going to be necessary for this to be maintained in the years after the initial effort.  We’re not just concerned about current doctors in the Hudson Valley, but how to train the newcomers and sustain that going forward.

 

Lastly, we’re not satisfied with anything we do. We celebrate it for a second and then move on and build upon that. We’re not in for a short sprint and a victory lap. We’re in for stepwise, persistent, consistent longitudinal improvement

 

Why is it important to participate in leadership on a state and national level?

Effective leadership is one of the ingredients for a successful project. Since, by definition, you will have leaders in these projects, I think those leaders have an obligation to trumpet this from the mountaintops and allow the country the opportunity to generalize some of the things that are discovered that bode for success. If the leaders have the skill set to lead, and they believe in the patient-centered medical home, then they shouldn’t stop at their own community. They really need to help take the message out, because we all want this to be ubiquitous across the country.

 

 

 

 

Susan Stuard, executive director of the Taconic Health Information Network and Community (THINC)

 

Why are new models of care—such as the patient-centered medical home—important?

I think what the patient-centered medical home does is give a focal point–for the provider community and for the family and the patient–to the very necessary activity of care coordination. Many attributes of the PCMH are critical. I think this is one of the key transformative aspects, especially in terms of what’s happening nationally.

 

Many of us in the health care world understand that care coordination is one of the key aspects where, cumulatively, we haven’t been doing as good a job as we’d like to be doing. There’s room for tremendous improvements in quality, in controlling costs and with the patients’ experience–it gives us the opportunity to make their experience much more positive.

 

Why is what's happening in the Hudson Valley important to the advancement of new models of care, such as the PCMH?

The Hudson Valley is an “open” community; we don’t have the benefit of a large, integrated delivery system that organizations such as the Cleveland Clinic, Mayo or Geisinger do.

 

In our open community, we have a number of terrific community hospitals, primary and specialty physicians, long-term care providers, mental health providers, etc. All of these players function in a nonintegrated fashion. So it’s very important to test the patient-centered medical home and other changes in the care delivery system in an open community, where it’s theoretically more difficult to achieve integration and coordination of care, because we don’t have the infrastructure to make it happen.

 

We are showing that we can move the needle on care coordination, quality, cost and patient experience. It’s absolutely critical to this community, and we hope that anything we learn can be used to the benefit of open communities elsewhere.

 

Why is leadership on state and national levels an important part of your work?

We’ve been heads-down here in the Hudson Valley, working on these issues. We’ve realized, in the last several months, that it’s important to be out there talking about what we’re doing.

 

It behooves us to be out there, talking to partners and interested parties at state and national levels about what’s going on here. We need to be engaged so policymakers can avoid unintended consequences in policy design, so we aren’t working at cross-purposes with others that are doing valuable work in the areas of accountable care organizations and bundled payments, and so reimbursement systems can be appropriately realigned with how we think the care delivery system can be transformed.

 

We recognize we have the obligation to have those conversations and to share what our experience has been to date. It has not been all wine and roses. We’ve had some things go well, and we’re proud of that. We have also experienced some profound challenges, and continue to experience them and know that we will going forward. Nothing about this is easy.