Patient-Centered Medical Home Pilot Generating Pivotal Changes in Healthcare Delivery -1- ® By Marjie Harbrecht, MD Chief Executive Officer HealthTeamWorks Imagine a medical practice eas- ily accessible to patients via tele- phone or online, where your care is thorough, unhurried and personal. Your records are maintained elec- tronically, making them instantly available to clinic providers and referral physicians. Coordination with specialists and community healthcare resources occurs swiftly and smoothly. You develop a care plan with your doctor and work to- gether with your healthcare team to achieve your goals. Healthcare payers give incentives to the prac- tice for the value of the care it de- livers, rather than for the volume of care. That’s the patient-centered medical home (PCMH). The PCMH is a reality in 16 pri- mary care practices in Colorado that have participated in one of the nation’s first Multi-Payer, Multi- State Patient-Centered Medical Home Pilots, along with stake- holders at both local and national levels. Convened by HealthTeam- Works, the project began in 2008 and runs through 2012. It is one of many national endeavors initi- ated to demonstrate that resources invested in primary care result in better care, reduced cost trends and an improved experience for the pa- tient and the healthcare team. The medical home emphasizes whole-person orientation with co- ordinated care across all elements of the healthcare system. The PCMH features: • Enhanced access, making it easier for patients to contact their personal healthcare team; • Emphasis on prevention and proactive management of chronic conditions, improving clinical quality and safety; • Engaging patients in their care to attain optimum health; • Practice redesign using a team- based approach, including care coordinators/care managers; and • Technology, such as electron- ic health records with ability to facilitate information ex- change, and report data. Colorado’s PCMH pilot among most complex The Colorado PCMH pilot tests the model in 16 small indepen- dent family medicine and inter- nal medicine practices along the Colorado Front Range. Payment for the pilot began in May 2009, once practices met requirements to achieve Medical Home recogni- tion from the National Committee for Quality Assurance (NCQA). The participating health plans — Anthem-Wellpoint, United Health- care, Humana, Aetna, CIGNA, Colorado Medicaid and CoverCol- orado — pay practices for 20,000 covered patients, although prac- tices provide services to more than 100,000 patients. The Colorado effort stands apart because of its complexity — seven public/private payers are involved — and the level of collaboration among those payers. The health plans joined the program volun-
Transcript
Patient-Centered Medical Home Pilot Generating Pivotal Changes in Healthcare Delivery
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By Marjie Harbrecht, MDChief Executive OfficerHealthTeamWorks
Imagine a medical practice eas-ily accessible to patients via tele-phone or online, where your care is thorough, unhurried and personal. Your records are maintained elec-tronically, making them instantly available to clinic providers and referral physicians. Coordination with specialists and community healthcare resources occurs swiftly and smoothly. You develop a care plan with your doctor and work to-gether with your healthcare team to achieve your goals. Healthcare payers give incentives to the prac-tice for the value of the care it de-livers, rather than for the volume
of care. That’s the patient-centered medical home (PCMH).
The PCMH is a reality in 16 pri-mary care practices in Colorado that have participated in one of the nation’s first Multi-Payer, Multi-State Patient-Centered Medical Home Pilots, along with stake-holders at both local and national levels. Convened by HealthTeam-Works, the project began in 2008 and runs through 2012. It is one of many national endeavors initi-ated to demonstrate that resources invested in primary care result in better care, reduced cost trends and an improved experience for the pa-tient and the healthcare team.
The medical home emphasizes whole-person orientation with co-ordinated care across all elements of the healthcare system. The PCMH features:
• Enhanced access, making it easier for patients to contact their personal healthcare team;
• Emphasis on prevention and proactive management of chronic conditions, improving clinical quality and safety;
• Engaging patients in their care to attain optimum health;
• Practice redesign using a team-based approach, including care coordinators/care managers; and
• Technology, such as electron-ic health records with ability to facilitate information ex-change, and report data.
Colorado’s PCMH pilot among most complex
The Colorado PCMH pilot tests the model in 16 small indepen-dent family medicine and inter-nal medicine practices along the Colorado Front Range. Payment for the pilot began in May 2009, once practices met requirements to achieve Medical Home recogni-tion from the National Committee for Quality Assurance (NCQA). The participating health plans — Anthem-Wellpoint, United Health-care, Humana, Aetna, CIGNA, Colorado Medicaid and CoverCol-orado — pay practices for 20,000 covered patients, although prac-tices provide services to more than 100,000 patients.
The Colorado effort stands apart because of its complexity — seven public/private payers are involved — and the level of collaboration among those payers. The health plans joined the program volun-
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tarily. They compensate providers using a blended payment model — fee-for-service, per-member-per-month for care coordination, and a pay-for-performance bonus.
HealthTeamWorks serves as the convening organization for the PCMH Pilot practices in Colorado. It also provides in-office coaching, innovative technology support and learning collaboratives to devel-op PCMH processes and culture change, and bring participating practices together to share expe-riences. The pilot is evaluated by Meredith Rosenthal, PhD, from the Harvard School of Public Health, to determine the effect on quality, cost trends and satisfaction for pa-tients and their healthcare teams.
The Commonwealth Fund and the Colorado Trust fund the pilot.
Results show model is working
May marks the two-year anni-versary of the PCMH pilot in Colorado, and early results are promising. Practices have made tremendous strides in building in-frastructure, including on-site care management services. Trends are showing improvement on qual-ity measures, coordination of care and satisfaction. For example, the graph depicts the pilot’s success in improving measures for diabetic patients from June 2009 to Decem-ber 2010. Practices also target car-diovascular disease, depression, and prevention.
The PCMH is based on years of research that supports the need to bolster and reorganize the deliv-ery of primary care and how it’s paid for. But medical homes alone won’t be sufficient without support from the medical neighborhood. Every segment of the healthcare system stands to benefit from this coordinated patient-centric ap-proach: patients, providers, em-ployers and payers.
Higher goals for pilot’s next two years
During the pilot’s next phase, HealthTeamWorks’ will continue to:
• Provide on-site coaching to im-
Reprinted with permission from the Colorado Healthcare News. To learn more about the Colorado Health-care News visit colhcnews.com.
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prove clinical quality, coordina-tion of care and satisfaction;
• Connect practices for peer-to-peer learning;
• Promote information sharing between the health plans and physician offices;
• Focus on reducing healthcare costs by decreasing emergency room use, hospital admissions/readmissions, and pharmaceu-tical costs; and
• Expand connections with “medical neighborhoods,” in-cluding mental health, special-ists and hospitals.
We are very proud of what our
pilot practices have achieved in two years, and we know they will accomplish even more going for-ward. They are transforming the paradigm of healthcare delivery in a way that is patient-centered, effective and affordable. The pa-tient-centered medical home will provide a foundation for health-care transformation in this country as we move toward more integrat-ed community care.
Marjie Harbrecht, MD, is a board-certified family physician and CEO of HealthTeamWorks, which she has led since 1999. HealthTeam-Works is a nonprofit collaborative that implements and evaluates evi-dence-based care through redesign and culture change at the practice, community and healthcare system
levels. Harbrecht serves on several statewide boards and committees, including the Colorado Regional Health Information Organization and the Center for Improving Val-ue in Healthcare. She is a member of the national Patient-Centered Primary Care Collaborative Pay-ment Reform Taskforce and Cen-ter for Accountable Care, and the NCQA PPC-PCMH Advisory Committee that helped develop the 2011 PCMH standards. Har-brecht lectures nationally about health system change, quality im-provement and patient safety. She is an assistant clinical professor at the University of Colorado Health Sciences Center.
