EVOLUTION OF EMPLOYER-BASED GROUP HEALTH INSURANCE: FROM INDEMNITY/SERVICE PLANS TO MANAGED HEALTH INSURANCE PLANS – THROUGH 2000
thebrat
READING.2.B..pptx
1
The Shared Principles of Primary Care: A Call to Action
PDW and RPS Residency Education Symposium
March 26, 2018
Ted Epperly, MD
CEO | Family Medicine Residency of Idaho
Past President and Board Chair American |American Academy of Family Physicians Engagement Chair | Family Medicine for America’s Health
ACGME |Board of Directors COGME | Council Member
“IT WAS THE BEST OF TIMES, IT WAS THE WORST OF TIMES, IT WAS THE AGE OF WISDOM, IT WAS THE AGE OF
FOOLISHNESS.”
Charles Dickens
1
“INSANITY: DOING THE SAME THING OVER AND OVER AGAIN AND
EXPECTING DIFFERENT RESULTS.”
Albert Einstein
“NOBODY KNEW HEALTH CARE COULD BE SO COMPLICATED.”
Donald Trump
February 28, 2017
2
Why Primary Care?
A Greater Focus on Prevention
Early Management of Health Problems
Cumulative Effect of Primary Care to more Appropriate Care
Reducing Unnecessary and Potentially Harmful Specialist Care
9
Source: Starfield B., Leiyu S., Mackinko J., Contribution of Primary Care to Health Systems and Health, (Milbank Quarterly, Vol. 83., No. 3, 2005) 457-501)
Greater Access to Needed Services
Decreased Morbidity and Mortality
Better Quality of Care
More Equitable Distribution of Health in Populations
Lower Cost of Care
Better Self-Reported Health
High Value Care
Primary Care – Should Be The Foundation of All Health Care Systems in the World
World Health Organization – 2008
Institute of Medicine – 1994
Barbara Starfield – 1992
Commonwealth Fund - 2013
10
3
Joint Principles of the Patient Centered Medical Home
Personal Physician
Physician Directed Medical Practice
Whole Person Orientation
Care is Coordinated/Integrated
Quality and Safety
Enhanced Access
Payment
11
4
The Result:
Seven Principles of Person Centered & Team-based Primary Care
16
Person & Family Centered
Comprehensive & Equitable
Continuous
Coordinated & Integrated
Accessible
Team Based & Collaborative
High Value
5
Person & Family-Centered
Primary care is focused on the whole person - their physical, emotional, psychological and spiritual wellbeing, as well as cultural, linguistic and social needs.
Primary care is grounded in mutually beneficial partnerships among clinicians, staff, individuals and their families, as equal members of the care team. Care delivery is customized based on individual and family strengths, preferences, values, goals and experiences using strategies such as care planning and shared decision making.
Individuals are supported in determining how their family or other care partners may be involved in decision making and care.
There are opportunities for individuals and their families to shape the design, operation and evaluation of care delivery.
17
Comprehensive & Equitable
Primary care addresses the whole-person with appropriate clinical and supportive services that include acute, chronic and preventive care, behavioral and mental health, oral health, health promotion and more. Each primary care practice will decide how to provide these services in their clinics and/or in collaboration with other clinicians outside the clinic.
Primary care providers seek out the impact of social determinants of health and societal inequities. Care delivery is tailored accordingly.
Primary care practices partner with health and community- based organizations to promote population health and health equity, including making inequities visible and identifying avenues for solution.
18
6
Continuous
Dynamic, trusted, respectful and enduring relationships between individuals, families and their clinical team members are hallmarks of primary care.
There is continuity in relationships and in knowledge of the individual and their family/care partners that provides perspective and context throughout all stages of life including end of life care.
19
Coordinated & Integrated
Primary care integrates the activities of those involved in
an individual’s care, across settings and services.
Primary care proactively communicates across the spectrum of care and collaborators, including individuals and their families/care partners.
Primary care helps individuals and families/care partners navigate the guidance and recommendations they receive from other clinicians and professionals, including supporting and respecting those who want to facilitate their own care coordination.
Primary care is actively engaged in transitions of care to achieve better health and seamless care delivery across the life span.
20
7
Accessible
Primary care is readily accessible, both in person and virtually for all individuals regardless of linguistic, literacy, socioeconomic, cognitive or physical barriers. As the first source of care, clinicians and staff are available and responsive when, where and how individuals and families need them.
Primary care facilitates access to the broader health care system, acting as a gateway to high-value care and community resources.
Primary care provides individuals with easy, routine access to their health information.
21
Team Based & Collaborative
Interdisciplinary teams, including individuals and families, work collaboratively and dynamically toward a common goal. The services they provide and the coordinated manner in which they work together are synergistic to better health.
Health care professional members of the team are trained to work together at the top of their skill set, according to clearly defined roles and responsibilities. They are also trained in leadership skills, as well as how to partner with individuals and families, based on their priorities and needs.
22
8
High Value
Primary care achieves excellent, equitable outcomes for individuals and families, including using health care resources wisely and considering costs to patients, payers and the system.
Primary care practices employ a systematic approach to measuring, reporting and improving population health, quality, safety and health equity, including partnering with individuals, families and community groups.
Primary care practices deliver exceptionally positive experiences for individuals, families, staff and clinicians.
23
What Does This Mean For Primary Care in the U.S.?
Foundational
Align Health Care Systems around Primary Care and these Shared Principles
Delivery Model Innovations
Population and Community Health
Align Payment Mechanisms
Value Based Versus Volume Based Payment
All Rowing in the Same Direction
All Speaking With One Voice
Achieves the Triple Aim
24
9
10
The Result: Seven Principles of Person Centered
& Team-based Primary Care
16
Person & Family Centered
Comprehensive & Equitable
Continuous
Coordinated & Integrated Accessible
Team Based& Collaborative
High Value
5
TheResult:
Seven Principles of Person Centered
& Team-based PrimaryCare
16
Person &Family
Centered
Comprehensive
&Equitable
Continuous
Coordinated
&Integrated
Accessible
Team Based&
Collaborative
HighValue
5
