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Patient-Centered Medical Homes: The Promise and The Reality


Friday, May 30, 2014

While the Patient-Centered Medical Home (PCMH) model has increasingly been embraced by providers and payers as a way to improve health care and lower costs, many questions remain about its effectiveness. Definitions of medical homes vary, but they are generally known as a model that aims to transform primary care through increased coordination and communication among a team of providers. Recent medical home initiatives have encouraged primary care practices to invest in capabilities such as patient registries and electronic health records, and to achieve medical home recognition. Health plans offer to pay more to the practices that achieve recognition.

What do these models look like under different payers? Given variation in how PCMHs are set up and reimbursed, how scalable are these models? How long does it take for practices to make the PCMH transformation? What are some of the challenges practices face when making the transition? Do these models have an effect on costs? Do they improve quality of care?

Amy Gibson, chief operating officer, Patient-Centered Primary Care Collaborative, provided an overview of these models and highlight their impact on cost and quality.

Pauline Lapin, senior adviser, Center for Medicare and Medicaid Innovation, discussed the various primary care initiatives under the Innovation Center, including the Comprehensive Primary Care (CPC) initiative.

Amy Cheslock, vice president, Payment Innovation for Provider Engagement and Contracting at WellPoint, discussed private sector initiatives that support PCMHs.

Mark Frazer, an independent physician from Ohio participating in the CPC initiative, discussed the successes and challenges his practice has encountered while making the PCMH transformation.

Ed Howard of the Alliance moderated.

Follow the briefing on Twitter: #PCMH

Contact: Beeta Rasouli (202)789-2300 beetarasouli@allhealth.org

The event was sponsored by the nonpartisan Alliance for Health Reform and WellPoint.

Transcript, Event Summary and/or Webcast and Podcast

Transcript: Full Transcript (Adobe Acrobat PDF), 5/30/2014
Full Webcast/Podcast: Full Video

Speaker Presentations

Gibson Presentation (Adobe Acrobat PDF), 5/30/2014
Lapin Presentation (Adobe Acrobat PDF), 5/30/2014
Cheslock Presentation (Adobe Acrobat PDF), 5/30/2014
Frazer Presentation (Adobe Acrobat PDF), 5/30/2014

(If you want to download one or more slides from these presentations, contact us at info@allhealth or click here for instructions.)

Source Materials

Agenda (Adobe Acrobat PDF), , 5/30/2014
Speaker Biographies (Adobe Acrobat PDF), , 5/30/2014
Materials List (Adobe Acrobat PDF), , 5/30/2014
Selected Experts (Adobe Acrobat PDF), , 5/30/2014

Offsite Materials (briefing documents saved on other websites)

The Future of Patient-Centered Medical Homes: Foundation for a Better Health Care System, NCQA, 2/1/2014
The Patient-Centered Medical Home’s Impact on Cost & Quality: An Annual Update of the Evidence, 2012-2013, Patient-Centered Primary Care Collaborative, 1/1/2014
Limited Quality Improvement and No Cost Containment Found in a Medical Home Demonstration, RAND Corporation, 2/25/2014
Patient-Centered Medical Home Evaluations: Let’s keep them all in Context, Health Affairs Blog, 5/21/2014
NCQA Responds to Study: Association Between Participation in a Multipayer Medical Home Intervention and Changes in Quality, Utilization and Costs of Care, NCQA, 2/26/2014
Patient-Centered Medical Homes- the latest research findings: commentary from BCBSM, Blue Cross Blue Shield of Michigan, 3/6/2014
Making the Evidenced-Based Case for the PCMH, The American Journal of Managed Care Blog, 3/31/2014
Transforming Specialty Practice – the Patient-Centered Medical Neighborhood, The New England Journal of Medicine 370;15, 4/10/2014
Structuring Payment to Medical Homes after the Affordable Care Act [In Brief], The Commonwealth Fund, 4/7/2014
The Payment Reform Landscape: Payment for Non-Visit Functions and the Medical Home, Health Affairs Blog, 5/6/2014
Patient-Centered Medical Homes in Arkansas, Health Affairs Blog, 5/20/2014
Staffing Patterns of Primary Care Practices in the Comprehensive Primary Care Initiative, Annals of Family Medicine 12;2, 4/1/2014
Patient-Centered EHR Journey at the Community Health Level, Healthcare Informatics, 4/22/2014
Association between Participation in a Multipayer Medical Home Intervention and Changes in Quality, Utilization, and Costs of Care, JAMA 311;8, 2/26/2014
The Development of Joint Principles: Integrating Behavioral Health Care into the Patient-Centered Medical Home, Annals of Family Medicine 12;2, 4/1/2014
Leveraging Medicaid in a Multi-Payer Medical Home Program: Spotlight on Rhode Island’s Chronic Care Sustainability Initiative, The Kaiser Commission on Medicaid and the Uninsured, the Henry J. Kaiser Family Foundation, 11/1/2013
Managing Populations, Maximizing Technology: Population Health Management in the Medical Neighborhood, Patient-Centered Primary Care Collaborative, 10/1/2013
Medical Homes and Cost and Utilization among High-Risk Patients, The American Journal of Managed Care 20;3, 3/1/2014
Patient-Centered Medical Home Transformation with Payment Reform: Patient Experience Outcomes, The American Journal of Managed Care 20;1, 1/1/2014
Patient-Centered Primary Care Collaborative Fact Sheet, Patient-Centered Primary Care Collaborative, 5/1/2014
Structuring Payment to Medical Homes after the Affordable Care Act, Journal of General Internal Medicine, 4/1/2014
Value-Based Financially Sustainable Behavioral Health Components in Patient-Centered Medical Homes, Annals of Family Medicine 12;2, 4/1/2014
PCMH Initiative Produced Modest Economic Results for Veterans Health Administration, 2010-2012, Health Affairs, 6/1/2014
- Paul L. Hebert, C.F. Liu, E.S. Wong, S.E. Hernandez, A. Batten, S.Lo, J.M. Lemon, D.A. Conrad, D. Gremboqski, K. Nelson, S.D. Fihn

Photos

In Colorado, WellPoint found that through a medical home pilot it could achieve 18 percent fewer hospital admissions, and 15 percent fewer ER visits, Amy Cheslock, vice president, Payment Innovation for Provider Engagement and Contracting at WellPoint, stated at a May 30 Alliance briefing, Patient-Centered Medical Homes: The Promise and The Reality.

The Patient-Centered Medical Home model is incompatible with fee for service, Amy Gibson, chief operating officer, Patient-Centered Primary Care Collaborative, stated at a May 30 Alliance briefing, Patient-Centered Medical Homes: The Promise and The Reality.



Care coordination is 76 percent focused on post-hospital actions and the Center for Medicare & Medicaid Innovation (CMMI), already has over 300 practices regularly surveying patients, Pauline Lapin, senior adviser, Center for Medicare and Medicaid Innovation, said at a May 30 Alliance briefing, Patient-Centered Medical Homes: The Promise and The Reality.

The Patient-Centered Medical Home model is incompatible with fee for service, Amy Gibson, chief operating officer, Patient-Centered Primary Care Collaborative, stated at a May 30 Alliance briefing, Patient-Centered Medical Homes: The Promise and The Reality.

At Summit Family Physicians, becoming a PCMH reduced hospital visits by 160 patients in one year, but office expenses increased by 19 percent, Mark Frazer, an independent physician from Ohio participating in the CPC initiative said at a May 30 Alliance briefing, Patient-Centered Medical Homes: The Promise and The Reality.

 

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