The Journey at New Pueblo Medicine
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Transcript of The Journey at New Pueblo Medicine
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The Journey at New Pueblo Medicine
Mike Cracovaner, CEO
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Patient-Centered Medical Home
… a journey not a destination.
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Practice Demographics
Internal Medicine Practice12,500 Patients3,300 Medicare
1,400 Medicare Advantage7,800 Commercial /ASO
0 Medicaid (AHCCCS)
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Staff and Services7 Physicians (6 w/panels, 1 hospitalist)
2 Midlevels (1NP, 1PA)+/- 60 FTE
Lab (CLIA) + Anti-coagulation ClinicImaging Clinic (X-ray, Dexa)
Audiology, NCV, ABI, Adenosine Stress, Travel Clinic, Diabetes Education,
Clinical Research
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“We want to treat you well, make you well, and help you stay well during your lifetime.”
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Y2K
HMO Capitation FFS
Big Specialty Groups
High Quality: Service/Physician/Patient
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NPM Foundation for a Medical Home
4 Decades of practicePhysician/Patient Relationships
3 generation families utside Hospitalist
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Transition to an EHR
Physician Buy-in, Physician LeadershipTrain the Trainers
The VenturesHernan Cortez
The Causalities and Spoils of War
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Total CostHospital Incentives
Gainshare
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Why a PCMH?
Already had elementsApproached by UHC for pilot
PCMH additional incentives rewarding primary care for doing the right thing
for patientsFuture of healthcare =PCP stewardship
of resources
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What is PCMH?
Back to the FuturePhysician Led Team
Relationship with Patient/FamilyEvidenced Based Medicine
Measure and Reward Quality Outcomes
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“The good to great companies used technology as an accelerator of momentum, not a creator of it”
-Jim Collins
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Building a PCMH
Infrastructure
Processes
Outcomes
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Chronic Disease Management
DiabetesHypertension
CADDepression
COPD
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Managing Chronic Disease
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Preventive Measures
Cervical CA ScreeningBreast CA Screening
Colorectal CA ScreeningPneumovaxFlu Vaccine
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Health Maintenance
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Recall System
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“You got to admit it’s gettin’ better” -John Lennon
Weekly ED/IP ReportE-Prescribe
Patient contact/Patient educationCase Management
Cycle TimeLab Interface
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Patient Engagement
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OOPS…….
Patient Portal
Going Rouge: Physician/Patient email
Pick of the litter
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Positive Outcomes of PCMH
Disease managementPopulation management
Patient engagementStaff buy-in
Financial incentivesFirst mover advantage
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What’s The Future
“Health care reform” = “shifting risk to providers”
Payment for outcome vs. tran$action$Diagnostically Regulated Groupings (DRG)
Bundling paymentsAccountable Care Episodes (ACE)
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Accountable Care Organization (ACO)
Health Information Exchanges (HIE)
Cities and villages of Medical Homes
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Links for more infoNational Committee for Quality Assurance NCQAwww.ncqa.org/ Patient-Centered Primary Care Collaborativewww.pcpcc.netAmerican Academy of Family Physicianswww.aafp.org/pcmhAmerican Academy of Pediatricshttp://aappolicy.aappublications.org/American College of Physicianswww.acponline.org/advocacy/where_we_stand/medical_home/American Osteopathic Associationwww.osteopathic.orgUnitedHealth Group PCMH Demonstration ProgramEric Sullivan, [email protected] McKean, MBA Business Development Manager [email protected]