Christine Hunter on the Military Heallth System and the PCMH

This discussion will begin with an historical overview of the conditions within the Military Health System (MHS) that led to the policy decision from senior leadership to explore and develop the Patient-Centered Medical Home (PCMH). It will point out that stressors associated with multiple deployments and sustained military operations led to increased pressures on access and continuity with the MHS's primary care portals, particularly in the direct care military treatment facilities (MTFs). A corresponding lag in DoD beneficiary satisfaction with health care and the escalating use of the purchased care sector and ER's for non-emergent care was documented. The PCMH model of care was felt to offer a potential blueprint forward and was embraced by Leadership within the MHS at all levels. The presentation will then describe the demographics of the DoD beneficiary population along with some of the unique medical and sociocultural charactersitics of that population.The discussion will then describe some of the details of the PCMH journey for the MHS. The decision to use NCQA standards initially and the general approaches to moving the PCMH model forward in both the direct care and purchased care sectors of the MHS. The presentation will include a discussion of the key process and outcome measures that are currently being utilized and a review of some of the early results of the PCMH rollout among MTF early adopters in the direct care sector. It will also describe areas where we have experienced continued lags in expected outcomes, particularly in the area of continued ER overutilization. It will broadly discuss the current status of the MHS approach to incentivizing PCMH development in the civilian purchased care sector through various potential strategies.Finally, the seminar will wrap up with a description of current efforts with Secure Messaging pilots and the linkage to the MHS Patient Portal. The importance of patient activation as a key component of a successful PCMH and our intent to leverage evolving technology toward that goal will be emphasized and discussed.