Patient-Centered Medical Home – What, Why and How? (Blogger Briefing – IBM)

Patient-Centered Medical Home – What, Why and How? (Blogger Briefing)

Thanks to IBM and one of its most energetic leaders (and I’d say one of the most energetic leaders in health care), Paul Grundy, MD, a team of colleagues at IBM Healthcare and Life Sciences (noted on the last slide), and Laurie Friedman, the social media-savvy Communications professional at IBM who set the briefing up.

I tweeted some of the comments that Paul Grundy, MD, made about the “why” of Patient Centered Medical Home, which provides great framing for this discussion for a new audience (perhaps one that is less health care savvy), and there was a nice exchange of ideas tossed back and forth, from some my other favorite health care leaders, including Brian Klepper and ePatientDave.

I am mostly fascinated by the new ways that organizations and people are working to get ideas out there, and to connect with a wider group of stakeholders than normal (although if you know the work of PCPCC, they are known for being very inclusive to begin with). What would be next? A call with a chat transcript, or is there any other methodology to bring in this audience and put the comments out there for people who are there and aren’t there to learn? I’m not sure current Webinar-type technology fits this bill. In any event, it’s nice to see the information being put out there and the listening that goes along with it. It’s what Web2.0 is all about.


There is presently a lot of "activity" in the medical home arena (relabelled health care home within the Minnesota community). As one who is interested in not only relabelling and reconfiguring past models, but truly thinking creatively about "disruptive innovations" in the PCMH arena, we at ICSI (Institute for Clinical Systems Improvement) are actively engaged in a collaborative approach to identifying the elements, principles, scope, and payment which is necessary to truly bring about transformation in our delivery of health care, or perhaps better labelled as providing the environment to engage our citizens as key participants in their health.

While we've had some success with a single disease collaborative model at a statewide level (DIAMOND initiative), it's identified many of the cultural, organizational, and fiscal challenges which confront us.

As one small effort, we're establishing a small social network of 8 organizations to engage in conversations, dialogue, sharing, and challenging to address the "pressure points" which need consideration as we move forward. Large venues and webinars are valuable, but true dialogue, cognitive conflict when necessary, and creative thinking are essential. Looking forward to many ongoing learning conversations.


Thanks for writing more about your work at ICSI – I'd like to hear more!

Are you saying that DIAMOND was limited by current reimbursement models? Is there a link to what you did there?

Also, could you write more about what you are doing around social networking – are you using NING or some other tool? How's it going? Thanks for adding to the conversation,



DIAMOND is a multistakeholder effort, convened and facilitated by ICSI, which develops a new collaborative model for depression management in primary care (care delivery redesign), with an associated change in payment methodology across 8 payers, including Medicaid (payment reform), which now has 1 year experience, over 45 clinics, and over 2000 patients. More general information at:

While there is payment, as we progress, there is recognition that the initial considerations for cost were conservative, there's a major deficit with not being able to engage CMS and the Medicare FFS population, and we're trying to deal with this to make this financially viable without grant funding. This is being a first step in moving toward a medical/health care home model, using a one disease approach to learn about the opportunties and challenges of a widespread collaborative effort.

With regard to the social network, we're using conference calls,, and believe it or not creating a Twitter account (ICSIhope) as an experiment in moving into this area.

Always interested in learning more.


As Ted knows, it was a bumpy call for me to be on: some things just weren't clear. Later we found out it was because I never received the document that was sent out in advance!

But it turns out my somewhat puzzled micro-rant on my personal blog was pretty valid anyway, so after consulting with Laurie, I decided to leave it the way it is.

Long story short, I know all we/you wonky people have all kinds of wonky deep knowledge about this, but holy CRAP, why doesn't the general public know that IBM's data show that people living in integrated system have HALF the risk of heart attacks??

So I'm game to start a consumer rebellion: go to all the people who're taking our money in this game and say "Why aren't YOU doing it that way?? Do you not KNOW that way works better at the same cost??"

Dave, lots of information about lower heart disease in intergated systems by kaiser publised and on the net — I googled it and found 680,000. "We've reduced death from heart disease so significantly that it is no longer the leading cause of death among our 3 million members. In fact, death from heart disease is 30% lower in our NCAL Kaiser Permanente population than in the non-KPNC population in California." * As far back as 2002 this data has been out there.

If i had a choice as a consumer to buy my healthcare in an intergrated system like Kaiser I sure would !!! Why I work so hard to help the doctors in small practices get the method of payment and the tools to allow them to deliver care in a virtul intergrated system. Why I demand that our goverment (the largest buyer of care) reform the way it pays for care to drive care towards a system the values outcomes that can be intergrated.

We are starting to get some information on the financial Impact of practice transformation. (This from transforMED)

Publication of results from TransforMED's National Demonstration Project (NDP) began last week with the article, "Initial Lessons From the First National Demonstration Project on Practice Transformation to a Patient-Centered Medical Home" in the May/June issue of Annals of Family Medicine.TransforMED launched its two-year National Demonstration Project in 2006 and included primary care practices from around the country, studying the process of transforming to a Patient-Centered Medial Home. Additional articles on the outcome of this one-of-a-kind national study will continue to be published, including an extensive supplement to AFM scheduled for publication later this year. Congruent with the efforts of the NDP evaluation team, TransforMED has studied targeted financial data gathered from the NDP practices. The data demonstrate some critical findings about the impacts of practice transformation.

“There has been debate about whether small to medium sized practices can transform to a patient centered model of care. The answer from the NDP is a resounding "Yes!"”

There has been debate about whether small to medium sized practices can transform to a patient centered model of care. The answer from the NDP is a resounding "Yes!" There has also been an ongoing question about whether small to medium sized practices can implement an Electronic Health Record system effectively and efficiently. Again the evidence from the NDP is a resonating "Yes!"

Another national discussion is whether primary care practices can afford to transform; calling into question the financial impact on practices. The Evaluation Team's analysis of the NDP indicates that primary care practices can make substantial progress toward implementing components of the Patient-Centered Medical Home model. TransforMED's analysis of financial data gathered throughout the study reveal that they can do so while improving the finances of the practice as well as physician salaries. It is worth noting that about 70% of practices had an implemented EMR at the beginning of the project, and as a result many of the practices were also implementing EMR systems during the NDP. The analysis of financial data from the NDP demonstrates that practices do not have to experience a reduction in practice revenue as a result of meaningful practice transformation. In fact, the average NDP facilitated practice revenue increased 10.49% and 2.43% in the self-directed practices. Furthermore, physician salaries increased nearly 14% in facilitated practices and 13% in the self-directed practices. It can be deduced that the revenue and salary increases reflect increased efficiency because physician salaries actually rose at a greater percentage than the practice's increase in revenue.

These data demonstrate that primary care practices can accomplish meaningful, extensive practice transformation. Adequate attention to the "business of medicine" and effective practice management can lead to improved revenue and increased efficiency thus allowing the practice to absorb the cost of change and technology while improving the bottom line. Future data will most likely continue to demonstrate improved practice revenue and physician income as practices move past the challenges of transformation while providing solutions to the challenges facing the US Healthcare system.

Ted Eytan, MD