# Presentation: 698350

## Use of Secure Messaging inThe Advanced Medical Home:  A Patient-Centered, Physician-GuidedModel of Health Care

- Michael S. Barr, MD, MBA, FACPVice President, Practice Advocacy & ImprovementAmerican College of PhysiciansEmail: mbarr@acponline.orgPhone: 202-261-4531

**Notes:**
Approved by BOR 1/22/06
Represents one component of ACP advocacy efforts to help reform healthcare – and avoid the Collapse of primary care as we stated in our State of the Nation’s Health Care address on 1/30.

## The Advanced Medical Home Model...

**...****acknowledges that the best quality of care is provided not in episodic, illness-oriented, complaint-based care -- but through patient-centered, physician-guided, cost-efficient, longitudinal care that encompasses and values both the art and science of medicine.**

**Notes:**
The key principle underlying the AMH is that....

We are trying to address the shortcomings in the current delivery of healthcare through stating goals, developing policy to support those goals, and then using the policy to drive our advocacy efforts

## Key Attributes: Advanced Medical Home

_**Organize**_** the delivery of care for all patients according to the Care Model**
**Use of **_**evidence-based medicine**_** and clinical decision support tools**
**Coordinate care in **_**partnership**_** with patients and families**
**Provide enhanced and convenient **_**access**_** to care**
_**Identify and measure**_** key quality indicators**
**Use **_**health information technology**_** to promote quality, safety, security of information, and health information exchange**
**Participate in programs that provide **_**feedback on performance & accept accountability for process improvement and outcomes**_

**Notes:**
This is a system of care – practices would need to be “qualified” – which means that the practices can deliver these attributes...

## Framework for Reimbursement...

**...****acknowledges the value of both providing and receiving coordinated care in a system that incorporates the elements of the Care Model**
**...****aligns incentives so that physicians and patients would choose medical practices that deliver care according to these concepts**

**Notes:**
To support the AMH – we outline a framework for redesigning the reimbursement system to provide appropriate reimbursement and align incentives so that the model generates improved care – as well as a firmer base for primary care reimbursement.

## Framework for Reimbursement...

**...**_**incremental strategy**_** for reimbursement linked to infrastructure development; reporting of quality & cost measures;  performance (outcomes) **
**...**_**coordination**_** of care**
**...****adoption and use of **_**health information technology for quality improvement**_
**...****provision of **_**enhanced communication access such as secure messaging and telephone consultation**_
**...**_**remote monitoring**_** of clinical data**
**...**_**reduced administrative requirements**_** for practices**
**...**_**enhanced coverage and reduced co-insurance**_** for patients who select to receive care in an advanced medical home**

## Secure Messaging...Enhanced Communication Examples

**Non-urgent clinical advice**
**Scheduled follow-up “visits”**
**Coaching for self-management plans **
**Questions from family members **
**Automated generation of remote monitoring messages**
**Blood pressure**
**Peak flow**
**Blood glucose**
**Weight**

## References

**ACP State of the Nation’s Health Care:**
_**[http://www.acponline.org/hpp/statehc06.htm](http://www.acponline.org/hpp/statehc06.htm)**_
**ACP Advanced Medical Home monograph:**
_**[http://www.acponline.org/hpp/adv_med.pdf](http://www.acponline.org/hpp/adv_med.pdf)**_
**ACP Linking Physician Payments to Quality Care:**
_**[http://www.acponline.org/hpp/link_pay.pdf](http://www.acponline.org/hpp/link_pay.pdf)**_
**Enhancing Patient Care Through Interoperable Exchange of Electronic Healthcare Information:**
_**[http://www.acponline.org/hpp/quality_care.pdf](http://www.acponline.org/hpp/quality_care.pdf)**_