Patient-Centered Medical Home (PCMH):

A model of Delivering Primary Care

Presented by: Kimtuyen Tran Smith College ‘13 Undergrad,

CHCACT InternJune 13, 2012

Mission of Community Health Center Association of CT (CHCACT)

Mission of Federally Qualified Health Centers (FQHCs)

What is a Patient Centered Medical Home (PCMH) and Why It Is Important

CT’s PCMH Initiative

Purpose of Presentation

CHCACT is a Primary Care Association that provides training and technical assistance to FQHCs in CT

Mission: To enable CT FQHCs to provide access to the highest quality health care and social services to CT’s medically underserved populations.

Mission of CHCACT 1

FQHCs serve individuals in medically underserved communities

14 CT FQHCs 13 CT FQHCs are members of CHCACT FQHCs provide primary care, behavioral

health, and dental care

Mission of FQHC

The way in which healthcare is financed allows for poor areas to be underserved.

Private practices essentially run like a business Medicaid does not pay for the costs of care The uninsured cannot afford to pay for the costs

The Federal Government pays a cost-based reimbursement

Why do FQHCs exist?

65 million Americans live in officially designated primary care shortage areas

Only 27% of adults in U.S. can easily contact their primary care provider

50% of patients do not understand what their primary care providers told them because visits are too short to properly address their health concerns

Lack of coordination between PCPs, specialists, and hospitals

Crisis in Primary Care 2

PCMH Model

Patient Centered Medical Homes (PCMH) are not buildings, nursing homes, or hospitals, but a different way of delivering care.3

Adopted by AAFP, ACP, AAP, AOA 4: Personal Clinician (MD, NP, PA all of whom

have their own panel of patients and practice in primary care)

Clinician Directed Medical Practice Whole Person Orientation Care is Coordinated and Integrated Quality and Safety are Hallmarks Enhanced Access Payment Reform

Joint Principles of the PCMH

Workforce Supply and Training Obama Administration and HHS Announce New $250 Million Investment to Strengthen

Primary Health Care Workforce Through: (1) Creating additional primary care residency slots; (2) Supporting physician assistant training in primary care; (3) Encouraging students to pursue full-time nursing careers; (4) Establishing new nurse practitioner-led clinics; and (5) Encouraging states to plan for and address health professional workforce needs

Medicaid and Medicare Pilots Section 2703 of the Patient Protection and Affordable Care Act creates a new Medicaid

state plan option to cover medical homes, beginning January 1, 2011, under which certain Medicaid enrollees with chronic conditions could designate a health home, as defined by the Secretary. States that choose to offer this benefit option, will be reimbursed for payments by the federal government 90% for the first eight fiscal quarters.

Establishment of Center for Medicare and Medicaid Innovation within CMS. The purpose of the Center will be to research, develop, test, and expand innovative payment and delivery arrangements to improve the quality and reduce the cost of care provided to patients in each program.

Payment Reform Payments to primary care physicians. Requires that Medicaid payment rates to primary care physicians for

furnishing primary care services be no less than 100% of Medicare payment rates in 2013 and 2014.

Expanding access to primary care services and general surgery services. Beginning in 2011, provides primary care practitioners, as well as general surgeons practicing in health professional shortage areas, with a 10 percent Medicare payment bonus for five years

Health Care Reform: Opportunity to redesign the way health care is delivered and funded

Where are the PCMHs?

Picture Courtesy of NCQA PCMH 2011 Overview 5

EVIDENCE OF COST SAVINGS & QUALITY IMPROVEMENT 7

HealthPartners Medical Group BestCare PCMH Model

39% decrease in emergency department visits

24% decrease in hospital admissions per enrollee

Overall costs for enrollees decreased by 8%

Johns Hopkins Guided Care PCMH Model

24% reduction in total hospital inpatient days

15% fewer ER visits 37% decrease in skilled

nursing facility days Annual net Medicare savings

of $75,000 per PCMH care coordinator nurse deployed in practice

EVIDENCE OF COST SAVINGS & QUALITY IMPROVEMENT 7

Erie County PCMH Model

Decreased duplication of services and tests

Lowered hospitalization rates

Estimated savings of $1 million for every 1,000 enrollees

Community Care of North Carolina

40% decrease in hospitalizations for asthma

16% lower ER visits Cumulative savings of

$974.5 million over 6 years (2003-2008)

It builds on what FQHCs have been doing for years: Providing comprehensive primary care and

supportive services Being accountable for quality of care delivered

Chronic Care Model and Access Redesign

Reporting to stakeholders our performance measures

Evidence suggests that a PCMH improves outcomes and reduce costs

New payment systems are aligning with PCMH

Why should FQHCs become a PCMH?

CT’s goal is for 100% of Medicaid Patients to be in a PCMH by 2014

CT’s Initiative began for Medicaid patients in January 2012

Connecticut’s PCMH Initiative

Where are the PCMHs?

179 Sites and 663 Clinicians Recognized as PCMH in CT

Picture Courtesy of NCQA Recognition Directory 8

Motivation and Prioritization Across the Organization Initial Capital and Restructuring Costs Coordinating Care within the Practice and Beyond Staff Training Electronic Medical Records Scheduling (Extended/Alternative Hours of Service)

PCMH Challenges

1. Community Health Center Association of Connecticut. (https://www.chcact.org/Content/Who_We_Are.asp)

2. Health Affairs. "Patient-Centered Medical Homes.” September 14, 2010. (http://www.healthaffairs.org/healthpolicybriefs/brief.php?brief_id=25)

3. CT Health Policy Project. “FAQs about patient-centered medical homes in CT.” March 10, 2011. (http://www.cthealthpolicy.org/medicalhome/20110310_faqs_pcmh_ct.pdf)

4. Patient-Centered Primary Care Collaborative. “Joint Principles of the Patient Centered Medical Home” March 2007. (http://www.pcpcc.net/content/joint-principles-patient-centered-medical-home)

5. National Committee for Quality Assurance. “PCMH 2011 Overview.” January 13, 2011 (http://www.ncqa.org/LinkClick.aspx?fileticket=ag3nmIPXs5s%3d&tabid=631&mid=2435&forcedownload=true)

6. CT Medicaid Managed Care Council. “Care Management PCMH Committee: Patient Centered Medical Home Presentation.” May 17,2012 (http://www.cga.ct.gov/ph/medicaid/mmcc/pccm/minutes/2012/0517/PCMH%20Care%20Management%20Committee%20Presentation%20%205%2017%202012%20-Revised.pdf)

7. Patient-Centered Primary Care Collaborative. “Outcomes of Implementing Patient Centered Medical Home Interventions: A review of the Evidence from Prospective Evaluation Studies in the Unites States.” November 16, 2010 (www.pcpcc.net/files/evidence_outcomes_in_pcmh.pdf)

8. National Committee for Quality Assurance. Recognition Directory. (http://recognition.ncqa.org/PSearchResults.aspx?state=CT&rp=5)

9. Patient-Centered Primary Care Collaborative. “Introduction to PCMH Video,” 2010. (http://www.pcpcc.net/content/emmi)

References

Patient Centered Medical Home Video 9

Q & A