In its five-year history, the Patient-Centered Primary Care Collaborative(www.pcpcc.net) (PCPCC) already has emerged as a driving force in revamping the nation's health care system, creating both systematic and sustained changes in how health care is delivered and financed in the United States.
The PCPCC now has more than 1,000 member organizations that represent nearly every facet of health care, from payers to purchasers and from patients to physicians and other health care providers. It has been instrumental in demonstrating how the patient-centered medical home (PCMH) can achieve the goals of improved quality, enhanced patient access and lower costs.
In early 2012, the PCPCC hired Marci Nielsen, M.P.H., Ph.D., as its second executive director, giving her responsibility for leading the PCPCC as it strives to make the PCMH the cornerstone of the nation's health care system.
Nielsen is the former vice chancellor for public affairs at the University of Kansas School of Medicine in Kansas City and was an associate professor in the school's Department of Health Policy and Management. She was the first executive director and board chair of the Kansas Health Policy Authority (now the Division of Health Care Finance within the Kansas Department of Health and Environment), where she directed the Kansas Medicaid program, the State Children's Health Insurance Program, the State Employee Health Program and the State Self-Insurance Fund.
In addition, Nielsen served on the board of directors of TransforMED, a wholly owned subsidiary of the AAFP.
Nielsen's health care experience is not limited to the United States, however. She served as a Peace Corps volunteer early in her career, working for Thailand's Ministry of Public Health. She also served for six years in the U.S. Army Reserves.
AAFP News Now recently sat down to talk with Nielsen about her goals for the PCPCC, how the work of the PCPCC affects family physician practices and the role of the PCPCC in advancing the PCMH on the state and national levels.
Q. Why did you want to become the executive director of the PCPCC?
A. I strongly believe that a strengthened primary care system via the patient-centered medical home is at the top of the list in terms of our ability to transform our health care system. By that I mean the triple aims of addressing cost, improving quality and, most importantly, improving health outcomes.
This, to me, was such a tremendous opportunity given my passion around these issues and given the timing of so many things that are happening across the country, including state engagement in the patient-centered medical home, real investment by commercial insurers around the patient-centered medical home, and certainly, the (Patient Protection and) Affordable Care Act's emphasis on the patient-centered medical home. This really is where the action is.
Q. What would you like to accomplish as the executive director of the PCPCC during the next few years?
A. There are all sorts of things that I think we need to do from a policy perspective around the patient-centered medical home, and then there are things I think we need to do within the Patient-Centered Primary Care Collaborative. There is significant overlap between the two.
In terms of the broader PCMH movement, I strongly believe that we need to engage the consumer in very real ways around their own care, but also around the movement itself. You will find that when you talk to average consumers, they have not heard of a patient-centered medical home. They don't understand why this is important. They don't understand the link between primary care and improved health outcomes for the country, which, of course, results in lower health care costs.
As part of that overall movement -- the PCPCC being one piece of the movement -- I think it is going to be very important in the months and years to come that we engage consumers in what we are doing. I am particularly well-positioned based on my own background to help advance knowledge and excitement around PCMH with consumers.
From the perspective of the PCPCC, we are coming to the end of my first 100 days, and I will be meeting with the board at the same time we have the April stakeholder's conference. I will be talking with them about our need for a sustainable business plan moving forward that grows our organization around our very clear priorities. Those priorities are advancing primary care and the patient-centered medical home. But they also include advocating for public policy that is consistent with primary care and the patient-centered medical home and providing a thoughtful and understandable evidence base to support it.
Q. What would you say to a family physician if you had to explain to him or her how the PCPCC affects his or her particular practice?
A. I would say three things. I would say at the practice level -- to the extent that family physicians are interested in engaging directly with us -- we have a number of tools, webinars, and networking opportunities for them as a physician practice to learn about the patient-centered medical home and get it implemented in their practice.
I would say at an association level, we have the four executives from the primary care associations (the AAFP, American Osteopathic Association, American College of Physicians and American Academy of Pediatrics) who sit on our board. And through those associations, they help to lead our organization. They are very important in setting the direction for the PCPCC.
The third way is at the policy level. We work with commercial insurers, employers and consumers, and, thus, we are able to impact public policy in a significant way. We are uniquely situated. There are not broad collaboratives like the PCPCC that exist in other industry-specific sectors of health care. We are unique in that regard. We partner very directly through our leadership with health plans and with employers, and we are able to have a bigger impact on public policy. We are pushing for primary care and the PCMH as a way to transform our health care system.
Q. What role does the family physician play in making the consumer more aware of the patient-centered medical home?
A. There are several things that we can and should be doing to engage consumers. The first thing that we need to do is figure out what the key messages are that resonate with consumers. We, as providers in the policy community who have taken on the PCMH, largely understand what it means and are integrating it into practices all across the country. But we haven't figured out how to talk to consumers about this. I would say the first work that needs to be done is we need to be talking to consumers directly to help understand what part of PCMH and primary care resonates with them.
Q. How specifically can physicians do this?
A. The process of transforming a practice into a PCMH is not easy or quick. Physicians should be able to communicate some things to patients -- to tell them, "Here are some things that you can expect in terms of better delivery of health care from our offices, and here is why the (PCMH) is important, and how it will benefit you."
I have no doubt as practices are disrupted by some of the changes that are being made, physicians are trying to communicate why they are doing this and how they are doing this with their patients. I don't know that the PCPCC has helped them figure out what those messages are.
Q. How would you describe the PCMH in the context of the health care system?
A. There is not unanimity on this question. We have people on our PCPCC board who say the PCMH is not a model, but a process, meaning it is not an end point at which you ultimately arrive. We will continue to learn new things about what works in these practices, and we need to continually update and improve physician practices based on those lessons.
I am someone who looks at the PCMH as a process. That process includes some key features, and various practices will integrate various features as is appropriate to their practices. Those features include coordinated care, comprehensive care, patient-centered care and helping to ensure patient access to care. The bottom line is that the PCMH is at the center of a medical neighborhood, coordinating care and services for systems built around that and supporting it via health information technology and payment reform.
Q. It is generally believed that having adequate payment for the PCMH by public and private insurers is one of the keys to facilitating adoption of the PCMH and guaranteeing its sustainability. What role will the PCPCC have in securing adequate payment for physician practices that adopt the PCMH?
A. I would answer that question by clarifying the role the PCPCC plays in the entire PCMH movement, not just around payment reform. We are really a convener of experts and interested stakeholders to disseminate information. The folks at the PCPCC are not necessarily the ones you would call and ask for specific technical expertise. Rather, you call us and ask, "Who provides this type of service, and is it important?" We facilitate that information both through our website and through our publications, meetings etc.
That is the same type of support we provide around payment reform. We have a payment reform task force. We are certainly looking to disseminate information. And as we work with policymakers, we think it is very important to highlight the importance of payment reform to make the PCMH work.