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Monday, June 25

Two Way Asychronoous Communication - EHR

The Primary Care Model of the Future 


  • Prevention and healing vs. testing and prescribing
  • PCMH Team Care: providers and health coaches
  • Encounters vs. office visits
  • Pro-active Health Risk Assessments
  • Technology: EHR, RelayHealth, mobile monitoring
  • Address behavioral issues
  • Community integration

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New Model - Blends Two Key Elements 

Patient-Centered Medical Home Model 

  • Team-based  
  • Technology-enhanced and connected 
  • Dashboard-enabled 
  • Home-based  hub for biometric monitoring 
  • Chronic Care Management

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Population Health Management Model

  • Health Risk Assessment “Plus” 
  • Prescription for better health (shared decision model) 
  • Proactive outreach—keep healthy people healthy (apps, interactive tech) 
  • Health coaching (live, phone, virtual) to address risk factors and chronic care

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    Evidence That it Works

    Patient-Centered Medical Home at Walter Reed 

  • Reduced ER visits by 6.8% 
  • Decreased pharmacy costs by 12.9% 
  • Achieved $333 annual cost reductions for chronic care patients 
  • Improved HEDIS (quality) scores, as well as access and patient trust

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