The patient-centered medical home, or PCMH, has emerged as a driving force in revamping the nation's health care system because the model is leading to systematic and sustained changes in how health care is delivered and financed in the United States. That was one of the major themes to come out of the Patient-Centered Primary Care Collaborative's, or PCPCC's, annual summit here on Oct. 21.
"We really have some great movement around the medical home. We are seeing some great results," said Paul Grundy, M.D., director of health care technology and strategic initiatives for IBM and co-chair of the PCPCC.
Grundy pointed out that at least two major departments within the federal government -- the Department of Defense and the Department of Veterans Affairs -- are moving toward implementing the PCMH. The medical home itself is indicative of how the health care system is "migrating from health care of little value to smart health care," Grundy said.
Like other speakers who addressed the PCPCC summit, however, Grundy decried the current state of the nation's health care system, saying health care in the United State is "twice as expensive as any other country on the face of the earth." The value of that care is by far the lowest of any developed nation, he added, noting that in 1951, three nations had longer life expectancies than the United States, but today that number stands at 67.
"We really need to focus like a laser on redesigning our payment system for value" rather than relying on fee-for-service payments and subspecialty care, said Grundy.
Peter Lee, J.D., director of delivery system reform in the Office of Health Reform at HHS, addressed some of Grundy's concerns by explaining that HHS has developed a national strategy that will affect how care is paid for, how it is measured and how it is supported. This national strategy is based, in large part, on the triple aims(content.healthaffairs.org) of CMS Administrator Donald Berwick, M.D., who has called for a health care system that improves the experience of care, improves the health of populations, and reduces the per capita cost of health care.
HHS asked for comments on how to accomplish these triple aims earlier this year, and, according to Lee, 350 groups submitted comments. "The comments were rich, they were informative and anchored in things that will ring true around things that folks in this room have been working on for many years," Lee noted.
He added that many of the comments called for greater care coordination and integrated care, as well as support for more effective primary care. Comments also addressed the need for alignment within the federal government and between various agencies, such as HHS and the Department of Defense, in implementing the triple aims.
"The issue of alignment was one of the themes that came up again and again," said Lee. "That is something that clearly this collaborative (the PCPCC) has been working on for a long time."
Lee also identified key components of an effective health care system, including patient-centeredness, health information technology and seamless patient transitions from one physician to another. These key components are "in many ways baked into medical homes," he said.
Lee also described some of the benefits of the Patient Protection and Affordable Care Act. For example, the act will help shift the focus of the U.S. health care system from an acute care model to a prevention and wellness model.
"The Affordable Care Act actually increases payment for primary care and sets in motion value-based payments," Lee said.
In addition, HHS and CMS are preparing to launch a multipayer Advanced Primary Care Practice Demonstration(www.hhs.gov) that will have Medicare joining with Medicaid and private insurers in state-based efforts to improve the delivery of primary care and lower health care costs. Twelve states have applied to participate in the demonstration project, and HHS plans to choose which states will be a part of the program within the next few months.
The health care reform legislation also creates accountable care organizations, or ACOs, within Medicare that will operate as a shared savings program. By law, participating ACOs have to be accountable for quality and costs for a minimum of 5,000 Medicare beneficiaries. They also are required to enter into an agreement with Medicare for three years and to have enough primary care physicians and other primary care health professionals to take care of their covered populations.
HHS is in the process of developing rules for ACOs that will be put out for comment before the end of the year, Lee said.
As with past PCPCC summits, this year's summit highlighted the success of PCMH-based programs in various parts of the country, including the Illinois Medicaid program, which has saved $500,000 million during the past few years by implementing two separate but complementary medical home and disease management programs for Medicaid recipients.
The first program, known as Illinois Health Connect(www.illinoishealthconnect.com), or IHC, is a medical home model that delivers care to 1.8 million of the state's 2.6 million Medicaid recipients. The other program, Your Healthcare Plus, provides care to 260,000 Medicaid medical home recipients with one or more chronic conditions. Together, the programs saved $180 million during the 2008 fiscal year and $320 million during 2009, according to Margaret Kirkegaard, M.D., M.P.H., of Downers Grove, Ill., a family physician and medical director of the IHC.
"Not only are we able to provide good care through the medical home model, but we have saved money," said Kirkegaard.
Family physician Carrie Nelson, M.D., medical director of Your Healthcare Plus, described some of the finer points of the program, explaining, for example, that Your Healthcare Plus employs 170 field staff who live and work in the communities they serve.
"We also use sophisticated predictive modeling tools that will help us stratify the patient populations so we know to what degree we need to focus our resources," Nelson said.
In the final analysis, she said, Your Healthcare Plus is "constantly trying to reinforce the need to connect to the patient-centered medical home and to enhance (patient) adherence to the physician's treatment plan."