Fine Print: Patient-Centered Medical Homes

Beth Fitzgerald | April 17, 2012 | Health Care
New model for coordinated care grows as national committee recognizes NJ primary care practices

What it is: A Patient-Centered Medical Home (PCMH) is a primary care practice that meets the standards set by the National Committee for Quality Assurance, a nonprofit founded in 1990 with a mission to improve primary care. The committee developed PCMH standards with the four national organizations representing primary care physicians: the American Academy of Family Physicians, the American Academy of Pediatrics, the American College of Physicians and the American Osteopathic Association.

What it means: To achieve national committee recognition, the medical care delivered by a PCMH must be organized in ways that are focused on the patient. The staff, including physicians, nurses, medical technicians, IT and administration, work in teams to coordinate and track the care patients receive over time. When the PCMH refers patients to specialists and other healthcare providers, it communicates with all the providers in order to guide and coordinate care.

The goal is for healthcare to be a partnership that engages patients with their personal physicians, and when appropriate, the patient’s family. A PCMH seeks to be responsible for all the patients enrolled in the practice — those who come in for regular check-ups, and those who miss appointments and fall through the cracks.

The PCMH uses electronic medical records technology to keep track of patient care and to facilitate the creation of patient registries that aggregate information about the health status of patients with chronic diseases. For example, a registry of diabetics alerts the staff to those patients whose disease is not under control. The practice will then reach out to those high-risk patients and encourage them to come in for help with issues like nutrition and medication.

The role of electronic medical records: The committee encourages primary care practices to transform themselves gradually into a PCMH. Practices in the early stages do not need electronic medical records to be recognized as Level 1 medical homes by the committee. For Level 2 or 3 recognition, the committee wants the PCMH to use electronic medical records to e-prescribe medications, to communicate with patients, and to maintain registries that track the health of the patients in the practice.

The national picture: The committee has recognized 4,171 primary care practices nationwide as PCMH practices.

How New Jersey is doing: The committee has recognized 532 New Jersey primary care physicians as members of a PCMH, and has a directory of these doctors on its website.

The benefits of becoming a PCMH: Physicians say the PCMH model allows them to provide better care, devote more time and resources to the patients who need the most care, and achieve better health outcomes for their patients. And health insurers have begun making incentive payments to PCMHs, to reward the practices for providing a higher level of care, and to defray the cost of additional staff to coordinate care and to use IT to monitor population health. In New Jersey, Horizon Blue Cross Blue Shield of New Jersey, Aetna, and QualCare are among the payers now paying bonuses to PCMH practices.

PCMH milestones for New Jersey: Eight PCMH practices took part in a pilot that Horizon Blue Cross Blue Shield of New Jersey launched in 2011 to improve patient care, lower the cost, and share the money saved with the practices. Earlier this month Horizon reported that the 24,000 Horizon members in those eight practices had a 10 percent lower cost of care than a comparable pool of 1 million Horizon members who weren’t in a PCMH.

The pilot has since been expanded to 22 practices and 80,000 patients. It has achieved 26 percent fewer hospital emergency room visits. Other highlights: an 8 percent higher rate of improved diabetes control; 6 percent higher rates of breast cancer screening; and a 6 percent higher rate of cervical cancer screening.