John Tooker MD,MBA,FACP Chief Executive Officer/EVP American College of Physicians

1. Consumer-Purchaser Disclosure ProjectThe Patient Centered Medical HomeA New Model for Primary and Principal CareWashington, DCOctober 17, 2007 John Tooker MD,MBA,FACP Chief Executive Officer/EVP American College of Physicians

2. The Patient Centered Medical HomeScope of Presentation • Rationale for the model • Description of the model • Building consensus • The question we asked : • Is there a better way to organize and finance care by primary and principal care physicians that will lead to better outcomes, lower costs, and increased interest in general IM?

3. Patients Awash in Information, Patients Face a Lonely, Uncertain Road August 14, 2005 ( HOFFMAN,J) Sick and Scared, and Waiting, Waiting, Waiting August 20, 2005 (KOLATA) How Many Doctors Does It Take to Treat a Patient? June 27, 2007 (BACH) 55 % of adults surveyed said they were dissatisfied with the quality of their health care, up from 44 percent in 2000; and 40 percent said the quality of care had gotten worse in the last five years. Harvard University, AHRQ and the Kaiser Family Foundation (2004)

4. Wagner Care Model Community Health System Health Care Organization Resources and Policies Self-Management Support DeliverySystem Design Decision Support ClinicalInformationSystems Prepared, Proactive Practice Team Informed, Activated Patient Productive Interactions Improved Outcomes

5. Of a Like Mind • We found that other primary care groups—AAFP, AAP, and AOA—have policies that support physician-guided, patient-centered care through a “medical home” • AAFP, AOA, AAP and ACP joint principles incorporate the thinking of all four organizations into the “patient centered medical home” (PCMH)

6. Joint Principles of the PCMHAAP, AAFP, ACP, AOA March 2007 • Whole person orientation • Personal physician • Physician directed medical practice • Care is coordinatedand/or integrated • Quality and safety • Enhanced access to care • Payment to support the PC-MH

7. Building Consensus • AAFP, AAP, ACP, AOA – “Joint Principles” March 2007 • NCQA PPC PCMH qualification - July 2007 • Patient Centered Primary Care Collaborative Principles (PCPCC) May 2007 • ERIC • Consumers • Health plans (September 2007) • Physicians • QI organizations

8. Proving the concept – demos Private sector United PCPCC multi-player (plans and employers) Medicare demo Medicaid projects Costing the medical home project PCPCC summit – November 7th Current Events