Patient-Centered Medical Homes: Improving Quality, Reducing Cost

What is a patient-centered medical home?

Although there is no single definition of what constitutes PCMH, it is based upon the principle that savings and quality can be achieved by managing the wellness of a population through evidence-based health promotion and disease-prevention initiatives, and through the appropriate coordination of care for those with acute or chronic conditions. This strategy is centered on the primary care provider (family medicine, internal medicine, pediatrics) and empowers the provider to effectively manage their given patient population.

Various organizations officially designate provider practices as PCMH, by meeting specific criteria. These criteria vary by organization, but they all have common factors. Some of the more prevalent factors are:

Access – Patients must have appropriate access to care, through timely appointments for acute illnesses/injuries and wellness visits, extended hours for patient convenience and access to urgent care.

Communication – Effective and timely communication with the provider is an essential requirement, including the ability to contact the provider by telephone, as well as working toward providing the ability for secure e-mail between the patient and provider.

Disease registry – Computerized system of tracking the status of appropriate procedures, tests and interventions that have been established through evidence-based medicine, to be effective in improving the health status for patients with specific chronic conditions. Such registries are used during an appointment to ensure all of the appropriate orders and referrals have been completed and are also used to contact patients who are shown to be deficient with respect to any of the identified interventions.

Electronic health record (EHR) – Although not mandatory for meeting the initial phases of PCMH, an electronic health record provides the foundation for optimizing the effectiveness of the initiative. The EHR provides the foundation for the disease registry, but also provides the ability to access the record regardless of the provider’s physical location, enables other physicians to access the record for their treatment of the patient, and allows for the ability to report/trend specific laboratory and other diagnostic information.

Active participation of the patient/family – Education of the patient and family, and involving them in the management of their health and wellness is a crucial element in optimizing health status.

Are patient-centered medical homes achieving expected outcomes?

Although the concept of medical homes has been in existence since the late 1960s, it is only recently that third-party payers have recognized their potential benefit and developed demonstration programs to assess their effectiveness. As a result, most documented experience is from demonstration programs or recently transitioned demonstrations to live programs. The following table summarizes the latest results of some of these programs throughout the country:

Organization

Reduction in Patient Days     

Reduction in ER visits

  Total Savings

Community Care of North Carolina (for Medicaid recipients)

 

 —

16 percent   

  $516/patient/year

Group Health – Seattle, WA

11 percent

29 percent

 Returned 150 percent of investment

Geisinger Health System – Pennsylvania

14 percent

20 percent

  7 percent

Johns Hopkins (for Medicare patients)

24 percent

15 percent

  $1,364/patient/year

 

Each of these programs developed different systems with different incentive models. However, each achieved significant savings, and all have transitioned their demonstration projects to full programs. It is also noted in these studies that patient satisfaction, as well as the satisfaction of the primary care providers, increased.

What does this mean for mid-Michigan?

PCMH is beginning to take hold in mid-Michigan. Blue Cross Blue Shield of Michigan has been in the process of designating PCMH practices, based on the achievement of specific criteria. Private practices, practices owned by Sparrow and Ingham Regional Medical Center and all MSU HealthTeam primary care practices have achieved this designation. Preliminary information from Blue Cross shows benefits are being realized. Additionally, other payers are beginning to develop PCMH initiatives that will impact mid-Michigan. Given this further integration of PCMH, the resulting benefit should be significant, and will accrue to our region’s patients, payers and employers.

Richard Ward is CEO of Michigan State University HealthTeam, the 230-member group practice comprised of faculty of the colleges of human medicine, osteopathic medicine and nursing.


 

 

 

 

 

 


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