Patient-Centered Medical
Home Overview
October 15, 2013
The Transitioning U.S. Marketplace
Employers
Demanding More
Value for Dollars
Spent on Healthcare
• Global competition
• Aging workforce
• High healthcare cost
structure
• Increasing demand for
productive human
capital
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Information about
Healthcare Cost and
Quality is Improving
• HIT Proliferation via
private and government
investments
• Consumerism-driven
cost and quality
transparency
Employers
Becoming More
Adept at Pulling
Levers to Get Better
Value
• Wellness Incentives
• Value-Based Insurance
Design
– Prescription benefits
– Medical benefits
• Medicare data
• Centers of Excellence
• Comparative
Effectiveness Research
• Pay for performance
Why PCMH?
• The PCMH model of care is associated with:
 Better patient health outcomes
 Higher patient satisfaction
 Lower per-capita costs
• Financial support available in SC for PCMH practices
 Monthly care coordination fees
 Bonus incentives based on performance improvement
 Financial rewards for seeking and achieving NCQA recognition
 Guidance and support through the NCQA recognition process
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PCMH “Basics”
Same-day appointments for patients who need
care
Promotes continuity of care and helps patients avoid
unnecessary use of the emergency room, retail clinics and
urgent care centers.
 Patients who have convenient access to their medical home are
less likely to seek care from other providers
Benefits:
•
•
•
•
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Reduces unnecessary use of the ER
Decreases patient use of retail clinics (fractured care)
Provides continuity of care which is associated with better health outcomes
Increases patient satisfaction
PCMH “Basics”
Clinical team meetings (AKA “Daily Huddles”)
• Care teams hold regular meetings to review upcoming
scheduled patient visits (“visit pre-planning”)
• Typically held daily, in advance of patient visits, and
include the following activities:
 Identifying gaps-in-care and establishing plans to
address needs during visit
 Review of specialist reports
 Review of lab and imaging reports
Benefits: More robust patient visits
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PCMH “Basics”
Population management & proactive outreach
• The ability to identify groups of patients by condition
and/or services needed
• Outreaching to patients who need care (letters, phone
calls)
Benefits:
• Prevents inactive patients from “falling through the
cracks”
• Improves performance on clinical measures
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PCMH “Basics”
Collaborating with patients and families to
develop care plans
• Providing patients with a written/electronic copy of their
care plans and treatment goals
• Providing education, tools and resources to help patients
better manage their conditions
• Tracking goals and progress with patients at each
relevant visit
• Assessing and addressing barriers when patients are not
meeting their goals
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PCMH “Basics”
Referral and test tracking
Formalized processes for tracking referrals and tests to
ensure:
 Results and reports are received timely
 Abnormal results are reviewed by clinicians
 Results are shared with patients
Benefits:
- Safety!
- Prevents “lost” results
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PCMH “Basics”
Continuous Quality Improvement
Capturing data that can be used to track performance on important
measures such as:
 Patient satisfaction
 Clinical measures (diabetic A1Cs, LDLs, annual eye & foot
exams, etc.)
 Preventive measures (physical exams, immunizations,
mammograms, etc.)
Having access to useful and accurate data helps practices identify
areas for improvement AND measure the success of improvement
activities.
Benefits: Improved performance
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Lessons Learned
 Successful recognition doesn’t guarantee a successful PCMH.
 Identify current problems in your practice and seek to solve
them through your PCMH transformation.
 Apply “R & D” techniques, wherever possible (Rip Off and
Duplicate)
 Having at least one engaged physician leader within the practice
is critical to success
 Change is practice-wide involving all staff working as a team and
at the top of their license
 Successful transformation leads to improved physician and staff
satisfaction
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And, most importantly…
 PCMH isn’t just for large practice systems!
 Smaller practices are more nimble
 Not as many layers of decision-makers (fewer people to
disagree!)
 Can define goals more quickly
 Communicate more easily
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