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Patient Centered Medical Homes: A Health Care Revolution Worth Supporting

Monday, October 10, 2011



A health care revolution already underway in Rhode Island

Soon, individuals seeking better medical care will need to look no further than their own doctor’s office. 

Everyone knows the healthcare delivery system is fraught with inefficiencies: providers not maximizing technology to share critical patient information, treating sickness versus health, duplicative testing and general inconvenience to the patient. The result? Gaps in care, higher costs and sicker patients.

Are PCMHs the Antidote?

So how do we improve the primary doctor relationship, emphasize prevention and better coordinate care? One increasingly popular solution to what ails patients is the Patient Centered Medical Home (PCMH).

In a PCMH, primary care physicians offer a holistic, more comprehensive approach to care. According to the American Medical Association’s Joint Principles of the Patient Centered Medical Home, a PCMH features seven shared characteristics:

  • personal relationship with a physician or other licensed practitioner who serves as team lead to the other practitioners who share in the patient care delivery
  • a team approach of providers
  • a whole-person approach to care over all stages of a person’s life
  • coordination of all care across the delivery system
  • quality and safety standards, including use of electronic medical records and optimal patient-centered outcomes
  • expanded access to care through open scheduling , expanded hours and modern communications methods
  • added value so that payments of physician practices recognize and reward for the added value provided to patients who have a Patient-centered Medical Home

PCMH Really ARE Patient Centered

PCMHs are designed to improve health and moderate long-term healthcare costs by focusing on preventive, proactive, and coordinated care.

Dr. Gus Manocchia, Senior Vice President and Chief Medical Officer at Blue Cross Blue Shield of RI, explains it this way:  “Essentially, the PCMH team serves as the “quarterback” in coordinating and navigating care, placing an emphasis on members with complex or chronic medical conditions. Practice staff and the doctors work to teach the patients how to best manage their own care and coach them in overcoming barriers to attaining good health. The whole practice is redesigned to go from all care being centered on the time the patient is in the office to providing a continuum of care.”

Are PCMHs Right for Every Practice?

While PCMHs have been around for some time, they’re just now going mainstream. But it may not be easy for every physician practice to convert to a PCMH model. 

Many would need to completely transform their practices to meet the requirements, like re-training physicians and staff and investing in technology to share electronic medical records. And that can be too costly or time-consuming. But for those who are willing and able, the payoff can be huge.

Dr. David Bromley, Senior Medical Director for Tufts Health Plan in Massachusetts, says, “For those practices who are able to make the change, nationally, there is increasing evidence that the approaches used in patient centered medical home practices have improved quality, particularly for people with chronic conditions like diabetes.  There is also evidence of improvement in patient experience and patient satisfaction as well as reduction in emergency department and inpatient utilization, resulting in lower cost.” 

Stakeholder Support is Critical

Buy-in is key to PCHMs’ survival and, fortunately, Rhode Island has lots of it.

The state has an ongoing pilot project with five practices and 28,000 patients participating. Known as the Rhode Island Chronic Care Sustainability Initiative (RICCSI), which is convened by the Office of the Health Insurance Commissioner, the program was developed by and is overseen by a strong coalition group that includes state government representatives, several physician practices and health systems, nonprofit community organizations, and all the health insurance carriers. 

What’s Next?

While the current focus of PCHMs in Rhode Island is on patients who are chronically ill, as more and more practices adapt to the model, the hope is that all patients will benefit. And the carriers can help drive the reach of PCHMs with their support. And they are.

In this state, insurers are offering:

  • provider reimbursement based on payment-per-patient-covered rather than by visit
  • pay-for-performance initiatives that lead to better health outcomes, shared savings from reduced hospitalizations
  • financial support for health information technology that improves quality

PCHMs are revolutionizing the way care is delivered to patients in this country. Hopefully soon they won’t be revolutionary, but the norm.

Amy Gallagher has over 19 years of healthcare industry experience.  As Vice President at Cornerstone Group, she advises large employers on long-term cost-containment strategies, consumer-driven solutions and results-driven wellness programs. Amy speaks regularly on a variety of healthcare-related topics, is a member of local organizations like the Rhode Island Business Group on Health, HRM-RI, SHRM, WELCOA, and the Rhode Island Business Healthcare Advisory Council, and participates in the Lieutenant Governor’s Health Benefits Exchange work group of the Health Care Reform Commission.

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