Healthcare Reform Navigation: Patient-centered medical homes

Growing concept calls for care to revolve around the patient, not the caregiver

Supplier success in a post‐reform healthcare market depends on a lot of factors, including a fundamental and thorough understanding of the foundation of healthcare reform. This is part of an ongoing series designed to help Repertoire readers understand the implications of reform.

Sales reps are hearing the term “patient-centered medical home” more often these days. That’s because the number of physician practices calling themselves “medical homes” is growing.

Patient-centered medical homes encompass five functions or attributes:

• They are patient-centered.
• They deliver comprehensive care.
• They deliver coordinated medical care.
• They provide increased patient access to care.
• They follow a systems-based approach to quality and safety.

The NCQA (National Committee for Quality Assurance) – an independent healthcare quality oversight organization – has been the leading organization in the PCMH movement, developing standards and criteria for medical homes to follow. Its goal with the PCMH Recognition Program is to transform primary care into what patients want it to be. This means:

• Patients have long-term relationships with clinicians, instead of sporadic, hurried visits.
• Clinician-led teams coordinate patient care, focusing on prevention and chronic conditions.
• Medical homes coordinate care needed by other clinicians.
• PCMHs offer enhanced access, with expanded hours and online communication.
• With shared decision-making, patients are able to make informed choices and get better results.
• Coordinated care leads to better overall quality of care.

Not a new concept
The term “medical home” is not a new one. The American Academy of Pediatrics introduced the term in 1967 to describe accessible, family-centered primary care. The concept continued to evolve, and in March 2010, the Patient Protection and Affordable Care Act launched provisions to grow primary care and medical homes, including payment increases and investments in medical home pilots. The term “Patient Centered Medical Home” appears in the law over 80 times.

In 2011, as a result of the Affordable Care Act, primary care providers began to receive Medicare bonus payments. What’s more, the Center for Medicare and Medicaid Innovation launched an Advanced Payment Model, offering savings and payment incentives for coordinated, patient-centered care. By 2012, 47 states had adopted policies and programs to advance medical homes. Today, providers receive a one-percentage-point increase in federal matching payments for preventive services, and health insurers have become focused on prevention, wellness, and chronic disease management.

NCQA recognition of PCMHs
Since PCMH accreditation began in 2008, the number of medical homes across the country climbed from 28 in its first year, to more than 5,700 in 2013. Along with the growth in practices, the number of physicians looking to become recognized as patient-centered medical homes grew as well, from 214 in 2008 to more than 27,000 in 2013.

In order to be recognized as a Patient-Centered Medical Home by the NCQA, a practice or physician must adhere to a six standards, which align with the core components of primary care:

1. Easy patient access. Patients select their physician, and have electronic access to the clinic and a team to provide care.
2. The practice collects data for population management, assesses and documents patient risk factors, and sends out proactive reminders for their patients.
3. Patients with specific conditions are identified, and physicians set and monitor treatment goals.
4. The practice works with patients and their families to develop self-care plans, counseling patients on healthy behaviors.
5. The practice tracks and coordinates patient care, managing care transitions among facilities.
6. The practice uses performance and patient experience data to improve their facility, and can demonstrate these improvements.

Along with these six standards, the practice or physician must satisfy six “must pass” elements:

1. Patients have access during office hours, which includes same-day appointments and access to timely clinical advice when needed.
2. Practices use the data they collect for population management. They develop preventative and chronic care services for patients.
3. Proactively manage patient care, developing care plans that engage patients and their families, with access to written plans and follow-ups for no-shows.
4. Patients are given the resources they need to educate themselves on their care.
5. Practices complete referrals to specialists in a timely manner, and follow up to make sure this care is coordinated.
6. Practices continually work to improve their services for the patients they help.

In 2012, The Patient-Centered Primary Care Collaborative (PCPCC) released a report showing results and outcomes from 40 patient-centered medical homes. The report showed, on some measures, that PCMHs increased the quality of patient care while reducing the overall cost of care. By engaging patients with their physicians, medical homes were contributing to reduced hospitalization and emergency room visits, contributing to overall systemwide savings.

Impact on supply chain
Primary care physicians who choose to move to the patient-centered medical home model need assistance with streamlining their practice and improving the overall patient experience. Sales reps can help.

PCMHs demand that multiple physicians coordinate their care. That means they must share data. Electronic health records play a major role in helping them do so. Furthermore, the PCMH model calls for physicians to find new ways to improve their patients’ overall experience in the office and at home. Physicians will be looking to add ancillary services and find other ways to maximize their time spent with each patient during their office visit, while improving the way they communicate with their patients concerning appointments, reminders and assistance with educational resources.

The patient-centered medical home model provides additional revenue opportunities for primary care offices. Once recognized as a PCMH, physicians and their practices will be looking for new ways to keep their NCQA recognition and move to the uppermost level, so they can maximize their incentives. Reps who are able to help their customers understand the six standards required for a PCMH and which products can help them in these areas will flourish with medical homes.

The patient-centered medical home is a growing concept. Reps need to be engaged in this conversation with their customers and find ways to provide value. They should use this opportunity to discuss the patient-centered medical home with all their primary care physicians.

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MDSI – the parent company of Repertoire – has developed the Healthcare Reform Navigation Series, an online program designed to make the task of preparing your organization for 2014 and beyond easier. This series will help you and your team with online courses that explain many of the key elements integral to understanding reform and the transformation from fee‐for‐service to fee‐for‐value. The program includes a 12-month schedule of topics and live sessions with industry experts.

To learn more about the Healthcare Reform Navigation Series, contact Tim Brack, director of training, education and meetings, at 770.263.5270 or tbrack@mdsi.org.