As pilot projects of the patient-centered medical home, or PCMH, model continue to roll out, some early adopters of the model are beginning to report the results of their PCMH pilots. One such early adopter is Geisinger Health System(www.geisinger.org) in Pennsylvania, a physician-led health care system that covers 43 counties. The company recently reported that its investment in the PCMH model has resulted in improved quality, lower costs, and greater physician and patient satisfaction rates.
Geisinger started rolling out the PCMH model in 2007, using it to drive sustained changes in its integrated health care delivery system. The result was the Geisinger ProvenHealth Navigator model, which now encompasses 31 Geisinger primary care practice sites and five non-Geisinger practices.
According to Thomas Graf, M.D., chair of the Geisinger Community Practice Service Line, during the past three years, Geisinger practices testing the ProvenHealth Navigator model saw a 40 percent reduction in hospital 30-day readmissions and a 20 percent reduction in overall hospital admissions when compared to a control group that did not use the system. In addition, the cost of care for patients in the test group was 7 percent less than the cost of care for the patients in the control group, Graf said.
At the same time, said Graf, physician, staff member and patient satisfaction rates among the medical home sites were far greater than the satisfaction rates among the control sites, based on surveys conducted by Geisinger.
"The patient-centered medical home allows you to do primary care the way you would want to do it," said Graf. "From our perspective, it is really the way we do business now. It is about knowing who all of the patients in your entire populations are, where they are, what is going on with them and then being proactive about managing them."
Geisinger has data on 85,000 patients covered by the ProvenHealth Navigator model and, thus, is able to compare cost and quality data for these patients with 150,000 patients who are enrolled in nonmedical home practices that contract with the Geisinger Health Plan. The health care system is now in the process of expanding ProvenHealth Navigator to other practices it contracts with, as well as to the remaining six Geisinger practices.
ProvenHealth Navigator "is our way of delivering care going forward," said Graf.
According to Graf, the goal of the ProvenHealth Navigator system is to provide physician-directed, team-based care based on core concepts, such as proactive outreach to patients and chronic disease management.
"Each person on the team has a specific function independent of the others, with the physician directing and referring the care," said Graf.
These core concepts, in turn, are coupled with 10 quality metrics that serve as guides for Geisinger's primary care system and that slowly evolve, according to Graf. Last year, for example, one of the metrics called for all ProvenHealth Navigator sites to achieve level-three PCMH recognition from the National Committee for Quality Assurance -- a goal that was met.
Other quality metrics address the entire spectrum of care, from office visits to electronic communications to case management.
Ronald Paulus, M.D., M.B.A., EVP for clinical operations and chief innovation officer for the Geisinger Health System, is convinced that the medical home represents the future of medicine if it is implemented and supported properly. He pointed out that the PCMH has been in the medical literature since the 1960s, but the concept has not "really taken off" because insurers and other entities are reluctant to pay for it.
Geisinger has addressed that problem by changing the payment structure to support the medical home. The health care system continues to pay physicians on a fee-for-service basis, but it also provides advanced practitioner stipends and staff bonuses and has directly increased the compensation of physicians by 10 to 15 percent.
Geisinger also furnishes practices with additional funds to help them carry out PCMH functions. The goal is to move from a volume-based to a value-based system, according to Graf. The company employs a gain-sharing program that gives the medical home sites the opportunity to earn bonuses if they meet certain cost goals and achieve quality standards. "If the practices hit 100 percent of their quality measures, and they save money, then they receive 50 percent of their savings," said Paulus. "If they hit 70 percent of their quality metrics and save money, they receive 70 percent of the 50 percent."
Paulus stressed that the medical home practices must save money and meet the quality goals to qualify for the bonus payments.