1

The Medical Home:

Successful Patient-Centered Care in College

Health

Sam JW Romeo, MD, MBA

sjwromeo@tower-health.com

2

Love of God & Family

3

My Medical Home Family

4

Patient Centered Medical Home

Medical Home History---1966 to 2014

5

Also know a little something about building a real life Medical Home

6

The MH Definitional Challenge

• Payer’s Model—Case management (Wagner) -7-10% savings (maybe)

• CMS’ Model– Meaningful Use/EHR“accountability”, PQRS, PQRI, HEDIS

-Inconsistent savings (if any)*

• The Primary care Professional’s Medical Home Model -30% savings*

7

Common Medical Home Evolving Goals—

• Improving the patient health care experience (including empowerment, satisfaction, engagement,

partnership)

• Reducing the Cost of health care (learning the distinction between needs and wants, Advanced Directives, end of life care and futile care)

• Improving the quality of health care provided(Not population or “statically significant” care, but personal/family valued care)

8

Reason for confusion?—Medical House versus Medical Home

Numerous objective components make up a (Medical) House

(General Contractors build quality houses…not homes…)

It’s not a (Medical) Home until there is trust, warmth, sharing commitment, and love within it

• That is what patients (students) and providers need!• That is the outcome payers & society needs!

9

Learning Objectives

• Understand the history of how we got to where were we are today in America’s healthcare and why reform is not a option, it’s required

• Define Patient (Student) Centeredness • Define Principles/Concepts of a Medical Home

– Relationship, Continuity, Access, Comprehensive, Quality• Describe a Medical (Student Health center) Home vs House• Highlight tools for success (as a Health center and an individual).

– HRA, End of life, Wellness (Spirituality, mental health, sleep, stress, nutrition, exercise, healthy relationships, finances,

– Self management, self care.

10

What Students don’t need!!

11

Why is the MH Model important for students---Healthcare (like College) is an active

participating process—Student centered!!

• For Students, College is • “delayed” adolescents ---• the transition from dependency to independence• the time for value setting and learning the bases for

rational thought.• the place to acquire the skills for deliberate and measured

and rational behavior.• the time for self determination and self reliance.• the time and place where faculty and staff hone the

students knowledge and skills for a productive and happy and healthy life.

12

Why is the Medical Home Model important to Faculty and Staff? –Professional values

• The traditional professions are Clergy, lawyers, teachers and physicians (healthcare providers)

• What makes a profession different from a trade?—Empathy (walk in their shoes).

• Student health centers cover the latter two professions if they have Empathy—(Providing care for STD’s and ADHD is not enough.)

• Guiding, teaching, supporting students (patients) is what Student Health Centers do—We all have to do it better.

13

“We the Patients” and the Requirements for the Medical Home Transformation

• Empowerment---engagement---involvement---accountable---partnership---invested---

• Integrating physical, social and behavioral care (and data).---“Putting the head back on the patient”---

---Attending the body, mind and spirit---

• Structure (House)---Process (Home)---Outcome (Empowered, accountable patient in a partnership)

14

The Challenge—The Medical Home Transformational Integrity requirements

(Empathy & Love) • As providers, we must acknowledge that without the

patient’s (student) partnership, involvement empowerment and individual investment, we will only change the location of the chairs on the Titanic.

• We must learn to provide Healthcare with patients (student) involvement, not “to or for” them!

• We must appreciate the distinction between a Medical House and a Medical Home. (A process innovation, not a product innovation)

15

Healthcare in the Student’s Future• Payer changes--Insurance & Self pay (out of pocket)

HSAsCo-paymentDeductible

• Provider changes--Training, payment, recruit, and retain (“primary care is currently not fun”)

Paid for Healthcare not disease careCapitation (per person, not per encounter)Wellness/prevention/healthy lifestyle support

• Patient (student) changes- - Life style choices—The only affordable options The healthcare vital signs of tomorrow(Health Risk appraisal/assessment)

16

Societal (Student) Healthcare Needs

• Accountability—to self, to family, to community• Transparency—Structure, process, outcome• Transformation--

• Partnership—doing with, not, to or for • Patient centered--- not disease centered• Care of patients--- with or without disease—body/mind/spirit• Healthy Lifestyle support/assistance—not a prescription• Wellness and prevention—not just disease screening• End of life discussions/considerations---not futile care• Functionally active—”getting back in the game”

17

Medical Home Model Principles & Transformation

• Relationship- Communication, Understanding, Collaboration, Trust, Love, Empathy, Partnership, Satisfaction/assessment

• Continuity of Care- Consultations, referrals, followed though completion, integrated, coordinated care in a single Patient Centered EHR,

• Comprehensive Care- Prevention, Wellness, HRA, Acute Care, Chronic Care, End of life care

• Accessibility- Availability, 24/7

• Quality- Clinical, administrative and patient assessments—there is evidence based, and patient based, formal, CQI process

18

A College Health Medical Home Relationship

• Not all patients who present to the College Health clinic/center are Medical Home patients---

• Need an enrollment process with informed consent/commitment from the student

• All staff needs to be able to identify the Medical Home committed patient—(EHR identity)—One consolidated Patient centered (not service or disease centered) record.

• The team understands that the patient is partner and a member of the team

19

A College Health Medical Home Continuity

• All staff support the health center/patient partnership ---all encounters, phone calls, e-mails, office visits—in the Patient centered Clinical Record.

• All consultations are recorded and tracked through completion

• One centralized patient centered clinical record containing all data/information

20

A College Health Medical Home Comprehensive Care

• Cradle to Grave care—Breath and Depth

• Wellness, Healthy Lifestyle support, Prevention, End of Life discussions

• Acute care and Chronic care

• Body/Mind/Spirit--- Healthcare--with or without “disease”

21

Health Risk AppraisalA Wellness Tool

The “Vital Signs” for a Healthy Life

• Exercise• Nutrition

• Self care Life Style Decisions• Sleep• Spirituality• Finances• Relationships

22

A College Health Medical Home Access

• Patient agrees to use the Medical Home as their primary site for care---(Except true Emergencies---or scheduled events as summer break/vacation)

• 24/7 access—If not provided, arranged and coordinated—continuity maintained and clinical record complete. (Call 911 or Go to the ER is inadequate)

• Patient participates in the coordination efforts including recording/reporting in the clinical record.

23

A College Health Medical Home Quality

• A formal CQI process is present and active—”If it isn’t measured & recorded, it didn’t happen”.

• Satisfaction assessment (and Dis-satisfaction) is a continuous processes for patient engagement and feedback as a partner.

• Assessing and assuring “Compliance” to the Medical Home principles (Relationship, Continuity, Comprehensive, Access, Quality).

24

Sam JW Romeo, MD, MBA

Tower Health & Wellness Center1801 Colorado Ave, Suite 290

Turlock, California

sjwromeo@tower-health.com209-216-3400

25

The Tower Health & Wellness Center