The patient-centered medical home: Understand why and how it’s changing primary care – and influencing all health care delivery

The third part in an ISMA Reports series*

e-Reports, December 17, 2012

The concluding part of our series on the patient-centered medical home (PCMH) offers some insights from colleagues and early results from pilot PCMH projects here and nationally. See Part I  and Part II.

PCMH in Indianapolis

Practices nearing NCQA recognition as a PCMH have good news for others. You are already doing many of the things required.

If your practice is moving toward meaningful use of an electronic health record (EHR) you also are progressing toward a PCMH.

“Many requirements for meaningful use Stage 1 overlap with certification requirements for PCMH,” said Todd Rowland, M.D., executive director for HealthLINC. “This overlap increases during Stage 2 meaningful use, so if you achieve Stage 2, you will have met many of the medical home requirements.”

Kathy Staples, R.N., M.B.A., who helps Community Health Network’s practices achieve PCMH status, said, “Standardizations happen with PCMH, but many components are there now. We’re doing them well, but it takes knitting them together and focusing to find efficiencies.”

John Miller, M.D., with Community’s County Line Medical Pavilion in Greenwood, already sees benefits of PCHM. “I’m really happy to have enough funding to hire a nurse care manager and more staff, and to be able to offer more comprehensive primary care.”

His patients enjoy increased access to specialty care, since network specialists accept all insurers. “When I have a person with an abnormal EKG, the cardiologists at Community Heart and Vascular take them in the same day – almost like a walk-in.” Dr. Miller thinks that’s the way it should be and removing access barriers is a key objective of PCMH.

Increased access is one of the patient benefits of this model physicians quickly recognize, said Joseph Schnecker, M.D., associate director of St. Francis Family Medicine Residency Program. He noted many practices have PCMH features, but do not go through the process of becoming certified or recognized. “Until the reward justifies the cost, practices will not seek certification, and there’s the perception now that cost of certification exceeds reward.”

And cost is a challenge, particularly for care coordinators. Insurers in some states are covering this cost; in other places, it’s absorbed by the ACO or hospital system. Costs can also mount for applications and resources to help with any recognition or certification process. Find free tools to get started at www.ismanet.org/go/ncqa121712.

PCMH in Evansville

Deaconess Health System started with two sites and hopes to have those NCQA recognized as PCMHs next year. But they are using a two-pronged approach that includes an “organizational roll-out” plan.
“We’re starting to implement some components all across the system, so the recognition process can go faster as we go along,” said Heather Orth, R.N., M.B.A., director of Accountable Care. They’re now getting practices accustomed to using clinical practice guidelines for chronic conditions.

“Making changes to the culture is one of our biggest challenges, and it’s a critical component of being successful,” said Orth. To help with culture change, Deaconess holds frequent team meetings at their pilot sites to ensure everyone is educated and informed.

Allen White, M.D., medical director for Deaconess Clinic and Deaconess Care Integration, explained PCMH lets doctors focus more on patient care and less on data entry. He suggested, “What if all the information you needed was already in the chart – put in there by someone else – before the patient visit?”

In the PCMH model, nurse coaches or care coordinators do chart reviews and ensure lab results and documentation are complete before the physician enters the exam room.

Dr. White also noted, “PCMH prepares you for the changes in health care reimbursement that are coming, as we move from fee-for-service to value based reimbursement. It gives you the tools and data to achieve the quality you need and prove it to the payers.”

Promising results from Deaconess

Deaconess has data to show the impact physicians can have with chronically ill patients. “We focused on COPD and diabetes patients and have seen tremendous growth and compliance on those measures, which helped get others on board,”
said Orth.

Dr. White agreed, “Doctors must see something is in this for their patients.” That’s when physicians buy-into PCMH. Here are some examples:

  • One pilot site, started with 19 percent of COPD patients having an annual spirometry test and within 10 months, 71 percent had the test.
  • A site looked at LDL measures for diabetic patients and saw the number increase from 86 percent to 97 percent of patients being tested; another’s results went from 78 percent to 95 percent on LDL measurement.

“This has been an extremely worthwhile and meaningful change in health care,” said Orth. “It is exciting because of the opportunity to increase physician satisfaction, improve patient care and really engage patients in their health care.”

*ISMA Reports will continue occasional reporting on PCMH progress in Indiana.
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Results from around the nation

The Patient-Centered Primary Care Collaborative (PCPCC), a coalition of more than 1,000 organizations working to advance primary care and PCMH, recently published a review of cost and quality results. It concluded: “Data demonstrate that the PCMH improves health outcomes, enhances the patient and provider experience of care, and reduces expensive, unnecessary hospital and emergency department utilization.” Here’s a sampling:

  • Florida’s Capital Health Plan increased primary care visits by 250%.
  • Maryland’s CareFirst BCBS saved nearly $40 million in 2011.
  • Community Care of North Carolina lowered ED utilization 23%.
  • Ohio’s Humana Queen City Physicians decreased ER visits by 34%.
  • UMPMC in Pittsburgh saw 20% long-term improvement in diabetics’ blood sugar control and 37% in cholesterol control.

Colorado started a multi-payer pilot PCMH in 2009. September’s Health Affairs
reported that while results are still being analyzed, the project “significantly reduced” emergency department visits and hospital admissions and allowed one of the six payers
to realize “a return on its investment of 250-400 percent.”

See more examples


Community’s County Line Medical Pavilion in Greenwood working toward PCMH recognition include: (back row, left to right) Kathy Staples, R.N., John Miller, M.D., Kelly White, Paula Rhude, Kris Stambaugh, Mery Kendall, M.D., Kristie Roell, Mary Blue and Esther Adade, M.D. (front row, left to right) Mary Kemp, Kathy Mullin, N.P., Amanda Frey, Jessica Petroff and Tiffany Brilley.
Not pictured: Rachel Kesecker and Terry Forss, N.P.