01-09d introduction to healthcare and public health in the us - unit 09 healthcare reform - lecture...

Introduction to Healthcare and Public Health in the US

The Evolution and Reform of Healthcare in the US

Lecture dThis material (Comp1_Unit9d) was developed by Oregon Health & Science University, funded by the Department of Health and

Human Services, Office of the National Coordinator for Health Information Technology under Award Number IU24OC000015.

The Evolution and Reform of Healthcare in the USLearning Objectives

2

• Describe evidence-based medicine, clinical practice guidelines, and quality indicators in medicine (Lecture a, b, c)

• Describe the patient-centered medical home model (Lecture d)

• Discuss the key issues driving healthcare reform in the US (Lecture e)

Health IT Workforce Curriculum Version 3.0/Spring 2012

Introduction to Healthcare and Public Health in the US The Evolution and Reform of Healthcare in the US

Lecture d

History of The Medical Home Concept

3Health IT Workforce Curriculum Version 3.0/Spring 2012


Lecture d

• 1967 -- The American Academy of Pediatrics (AAP) introduced the medical home concept

• 2002 -- the AAP expanded the medical home concept to include specific characteristics of patient care: – Accessible– Continuous– Comprehensive– Family-centered– Coordinated– Compassionate– Culturally effective

History of The Medical Home Concept (continued)

• The American Academy of Family Physicians (AAFP) and the American College of Physicians (ACP) have developed their own models for improving patient care – 2004 – AAFP “medical home”– 2006 – ACP “advanced medical home”



Lecture d

The Patient-Centered Medical Home (PCMH)



Lecture d

• 2007 -- Joint Principles of the patient-centered Medical Home delineated by:– American Academy of Family Physicians (AAFP)– American Academy of Pediatrics (AAP)– American College of Physicians (ACP)– American Osteopathic Association (AOA)

• The PCMH is an approach to providing comprehensive primary care

• The PCMH is a healthcare setting that facilitates partnerships

PCMH Characteristics: Personal Physician, Directed Medical

Practice



Lecture d

• Personal physician - each patient has an ongoing relationship with a personal physician

• Physician directed medical practice – the personal physician leads a team of individuals at the practice level – The team takes collective responsibility

for patient care

PCMH Characteristics: Whole Person Orientation



Lecture d

• Whole person orientation – the personal physician is responsible for providing for all the patient’s healthcare needs

• Care is provided in all stages of life• Preventive services are emphasized• Care is provided in multiple settings

– Acute care– Chronic care– End of life care

• Preventive services are emphasized

PCMH Characteristics: Coordination Of Care



Lecture d

• Care is coordinated and/or integrated across all elements of the healthcare system and the patient’s community

• Care is facilitated by technology• Clinicians provide care that is culturally

and linguistically appropriate

PCMH Characteristics: Quality And Safety



Lecture d

• Quality and safety measures:• Patients are encouraged to achieve

patient-centered outcomes• Clinicians use evidence based medicine

and clinical decision support tools to guide their decision making

PCMH Characteristics: Quality And Safety (continued)



Lecture d

• Other quality and safety measures:• PCMH model uses information technology

to support patient care• Practices agree to undergo voluntary

recognition process

PCMH Characteristics: Quality And Safety (continued)



Lecture d

• Other quality and safety measures:• Physicians participate in continuous

quality improvement and performance measurement

• Patients participate in decision-making• Patients and families participate in quality

improvement activities

PCMH Characteristics: Enhanced Access To Care



Lecture d

• Enhanced access to care facilitated by:– Open-access scheduling– Expanded hours– New options for communication

• Secure messaging and email• Use of personal health records

PCMH Characteristics: Payment



Lecture d

• Payment appropriately recognizes the added value of a patient-centered medical home

• Reflects the value of patient-centered care management work

• Pays for face-to-face visits as well as services associated with coordination of care

PCMH Characteristics: Payment (continued)



Lecture d

• Additionally, the PCMH payment model: – Recognizes case mix differences in the practice

patient population– Allows for additional payments when quality

improvements are achieved– Covers enhanced patient communication access to

clinicians– Supports adoption and use of health information

technology

The Evolution and Reform of Healthcare in the US Summary – Lecture d

15

• Described characteristics of the Patient-Centered Medical Home (PCMH) including:– Personal physician– Team approach to care – Whole person, integrated approach – Quality and safety measures– Enhanced Access– Payment

Health IT Workforce Curriculum Version 3.0/Spring 2012


Lecture d

The Evolution and Reform of Healthcare in the US

References – Lecture dReferences• American Academy of Pediatrics, Medical Home Initiatives for Children with Special Needs

Project Advisory Committee (2002). The medical home. Pediatrics, 110, 184-186.• Joint Principles of the Patient Centered Medical Home. (2007). Retrieved December 6, 2011,

from Patient-centered Primary Care Collaborative - American Academy of Family Physicians (AAFP); American Academy of Pediatrics (AAP); American College of Physicians (ACP); American Osteopathic Association (AOA) website: http://www.pcpcc.net/node/14.

• Pediatric Records and a "Medical Home". (1967). In Standards of Child Care (pp. 77-79). Evanston, IL: American Academy of Pediatrics.

• Physician Practice Connections®─Patient-Centered Medical Home (PPC-PCMH™) Recognition Program. Attestation/Agreement. (2007, December). Retrieved December 6, 2011, from The National Committee fro Quality Assurance website: http://www.coloradoafp.org/pdf/PPC-PCMH_Attestation.pdf



Lecture d

http://www.pcpcc.net/node/14

http://www.coloradoafp.org/pdf/PPC-PCMH_Attestation.pdf

01-09d introduction to healthcare and public health in the us - unit 09 healthcare reform - lecture...

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