Patient-Centered Collaborative Puts Stakeholders in Position to Drive Changes

The Patient-Centered Primary Care Collaborative, or PCPCC, has made major contributions toward reforming the nation's health care system by giving primary care physicians and other stakeholders the necessary information and tools to implement and sustain the patient-centered medical home, or PCMH. That was one of the key themes to emerge from a PCPCC stakeholders meeting here on March 30.

"We are focused on consumer engagement, employer engagement, primary care workforce supply, payment reform and implementation of the infrastructure that you need for the patient-centered medical home," said Edwina Rogers, J.D., executive director of the PCPCC, in her opening remarks to the nearly 350 participants representing almost every part of the medical community.

Panelists and other participants at the March 30 meeting discussed numerous topics and issues, including the advancement of care coordination, the alignment of incentives for sustainable value, practice transformation in the medical home and implementation of the medical home itself.

David Blumenthal, M.D., M.P.P., the national coordinator for health information technology at HHS, was one of two keynote speakers to address the stakeholders meeting. He praised the collaborative for its forward-thinking approach to health information technology, or health IT, as a critical component of PCMH implementation. "You recognize the value of not just primary care but of all the support systems that make it possible to deliver effective primary care," he told meeting participants.

"Long before the government created its current policies and blessed your insights, in a way, by recognizing the importance of health information technology, it was on your agenda, it was part of the core definition of the patient-centered medical home," said Blumenthal.

"You understood that information is the life blood of medicine, that any clinician is only as good as the information they have available to make decisions, and the best way, the most effective way to circulate that information is through electronic health information systems."

Last year, Congress passed the American Recovery and Reinvestment Act of 2009, or ARRA, an economic stimulus package that made substantial investments in health IT education and training programs for primary care physicians. The legislation contained two operative words to enhance the support structure for health IT: "meaningful use."

"Meaningful use is the key, in my view, to unlocking the potential of not only health information technology but of primary care, specialty care, hospital care -- indeed the potential for using that information in the most sophisticated ways for the purposes of improving health and improving efficiency," said Blumenthal.

CMS issued a proposed rule in late December to implement ARRA provisions that provide incentive payments for the meaningful use of electronic health records, or EHRs, through Medicare and Medicaid and to further define the term meaningful use.

The agency now is evaluating comments on the proposed meaningful use rule and plans to issue a final rule later in the spring, according to Blumenthal.

The rule is based on various domains, including quality, safety, and efficiency; the engagement of consumers and families; care coordination; and privacy and security. Blumenthal said this framework is powerful and fits in perfectly with the objectives of the PCMH.

One of the goals of health IT and EHRs is interoperability, or the seamless exchange of information, which requires incentives to encourage the exchange of that information, said Blumenthal.

He also talked about the creation of a nationwide health information network made up of organizations that have agreed to share information in a secure way. The network participants could share information about outcomes, processes of care and effectiveness of care, said Blumenthal.

But that level of sophistication may not be appropriate in the short term for all physicians and health care providers, said Blumenthal. They want to move the necessary data in a more direct way. As a result, HHS has started working on an experiment, dubbed the Nationwide Health Information Network Direct, that aims to make a secure Internet connection available for a simpler level of exchange, he said.