Ohio Department of Health, OAFP Collaborate to Launch Innovative PCMH Program

With the help of the Ohio AFP (OAFP), the Ohio Department of Health (ODH) recently turned a valve that will release a river of future primary care physicians flowing into the Buckeye state to provide higher quality health care.

The Ohio HB 198 PCMH Education Pilot Project (36-page PDF; About PDFs) was two years in the making. The project is unique because it not only transforms 50 carefully selected primary care practices into patient-centered medical homes (PCMHs), but it also uses those PCMH clinics to train medical students and primary care residents, as well as advanced practice nursing (APN) students, to deliver care in the new model.

According to Ted Wymyslo, M.D., ODH director and a member of the OAFP, the project also provides annual Choose Ohio First Primary Care Scholarships to 50 medical and 30 nursing students. To qualify for a scholarship, students have to participate in PCMH model training opportunities during medical school, commit to a post-residency primary care practice in Ohio for at least three years and accept Medicaid recipients as patients without restriction. Medical students will receive up to $30,000 per year (up to $120,000 total) and APNs will receive up to $10,000 per year (up to $30,000 total).

"The broader focus with this initiative is on education and attention to the pipeline of future primary care physicians," Wymyslo said. "Most of the prior pilot projects that relate to PCMH have been focused on putting practices into alignment with the PCMH principals and moving them all to National Committee for Quality Assurance recognition. This project is somewhat unique in that it really requires that any of the practices that participate in that transformation to also be teaching … and have an educational affiliation that is established with medical and nursing schools so that we cannot only transform the practice, but also ensure that we are teaching the next generation of clinicians in a setting that we feel is the ideal practice setting.

"We wanted to make sure that we enhanced the chance that students who were interested in primary care would maintain that focus throughout medical school," he added. "Hopefully then, those students would land in and stay in residencies and practices in the state of Ohio."

Ann Spicer, OAFP EVP, explained that the program is exciting because it is about so much more than simply transforming practices to the PCMH model.

"A lot of times, when medical students go out to primary care practices in their rotations, they see a lot of unhappy docs and a lot of dysfunction in the health care system and in the way that primary care practices are functioning," Spicer said. "So having this model available for them to look at and learn in a much better environment, it makes a much more positive impact on the students who are going to eventually be making a residency choice, which I think is huge."

Wymyslo also pointed out that, although he anticipates that the scholarship program will enhance recruitment and improve resident retention rates, the project doesn't require scholarship recipients to do their residency in Ohio.

"As far as training goes, we don't want to be prescriptive," he said. "They should go wherever they think they'll get the best preparation to practice. We just want to be sure that, ultimately … we get a return on the taxpayers' investment and that Ohio dollars come back to Ohio."

Spicer said some money from the scholarship program, which is funded through the Ohio Board of Regents, will go into one-time grants for PCMH curriculum implementation at the medical and nursing schools named in the project.

"This is a multipronged correction," she said. "It's not just a scholarship -- it's curriculum, it's giving students a practice environment in which they can see, experience and learn. It is a multifaceted thing, which is what makes it really exciting."

Without the OAFP, Ohio HB 198 probably would not have resulted in any concrete action, Wymyslo said. The bill passed the Ohio General Assembly in 2010 as an unfunded mandate, leaving Wymyslo with a big charge but no money or staff with which to make it a reality.

"They (the OAFP) were the largest organization involved in our initial coordination efforts," Wymyslo said. "They lent us their staff, their communications support. We held all our meetings at OAFP, and they helped us write our first grant for $300,000, which we got from the Ohio Department of Insurance to help us select the practices in the project. Their in-kind support was invaluable in allowing us to move forward."

The OAFP served 13 months as the management agent for the PCMH Education Advisory Group (EAG), the group charged with building the project infrastructure, before transferring the management role to the ODH in 2011. In January 2012, the ODH announced that the project had received $1 million from an $8 million federal bonus that the state's Office of Health Transformation received for signing eligible children up for Medicaid.

"That (grant) was a saving grace for us," Wymyslo said. "From there, TransforMED was selected to run a 50-practice collaborative that we are just kicking off now. We are a few years out from seeing a return on this investment, and not all of the students getting scholarships will be fourth-year students. But we had to start somewhere, or we were never going to get this done."

Wymyslo said the scholarship application process is in full swing now and that the Primary Care Medical Student Scholarship Selection Committee should be finishing up selecting the recipients.

"They'll be done soon, and those dollars will be going out in the first quarter of the (2012-2013) school year."

The results will be great for Ohio, Wymyslo said, as the practices in the program are expected to provide care to a population that, adding Medicaid and uninsured patients together, makes up 15 percent of their patient load.

"We all know that we are going to have a large influx into the Medicaid rosters as we move into insuring more people," Wymyslo said. "We have over 900,000 uninsured in our state, and they have to go somewhere (for medical care). This seemed like a responsible way to try and address that increased need that we expect to see when placing those on Medicaid and the uninsured into some type of a coordinated care model. Someone has to take care of these 900,000-plus people coming on board and I'd really like to get primary care practices in our state prepared to do it."

For her part, Spicer said she couldn't be happier with the results the OAFP's leap of faith produced.

"They don't all go out of the park, but it's good to hit one every once in a while," she said. "Our role has diminished, but we are really proud of what we did to get them up and running. Sometimes, you take these kinds of things on, and you know, at the time, you don't know whether you're going to find funding or if you're going to find someone else to take it on, but we definitely thought this was a very important thing to do and are really pleased with how it is coming along."