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PCPCC Stakeholders Meeting
PCMH Model Improves Care, Say Speakers, Pointing to Outcomes Data
By James Arvantes • Washington
BCBCND's statewide medical home initiative, which is known as MediQHome, began in 2009 and now provides care to 280,000 state residents, including 72 percent of all BCBCND patients. In addition, 72 percent of all primary care physicians in North Dakota participate in the MediQHome initiative.
MediQHome focuses on managing common chronic diseases, which have increased dramatically in North Dakota during the past 10 years. In addition, practices in the initiative focus on preventive care, such as immunizations and cancer screenings. "We track not only clinical outcomes but process measures, and we combine the two," said Hanekom. "There are more than 78 clinical metrics being tracked with our clinical support tool."
MediQHome provides care to entire populations, not just Blue Cross patients, Hanekom noted. "We have not taken the approach of 'We will look after our members, and you look after the rest of your practice population,'" he said. "It is important for a program to allow clinicians to do what they do best, which is to manage their entire (patient panel)."
- The most recent meeting of the Patient-Centered Primary Care Collaborative marked the collaborative's five-year anniversary.
- Speakers were able to point to a variety of outcomes data that demonstrate the effectiveness of the patient-centered medical home, or PCMH, model.
- The status and outcomes of several PCMH projects in the public and private sectors were shared.
"If you look at the literature, this means that people are living better lives and have less complications from diabetes," said Hanekom. "Here is a clear example of intermediate clinical improvement in a subgroup of patients who are very important to focus on."
Hanekom cited other findings, as well; for example, emergency room, or ER, use is 30 percent lower among MediQHome patients with chronic illnesses than among BCBCND's patients with chronic illnesses who are not enrolled in a medical home. Although ER use increased by 8.4 percent among BCBCND's general population, it decreased among MediQHome patients by 7.3 percent. And the inpatient hospital admission rate among patients the medical home initiative is 18 percent lower than that in the general BCBCND population.
The MediQHome findings came as no surprise to Melinda Abrams, M.S., vice president of patient-centered coordinated care for The Commonwealth Fund, who gave an overview of medical home outcomes data during the past five years to the PCPCC members.
PCPCC Releases Two New Documents
The Core Value, Community Connections publication addresses the theory and practice of collaborative health care. It includes articles from care-coordination experts on the definition, role and function of care coordination and tools for implementing, measuring and monitoring effectiveness. The booklet also provides case examples and survey responses from practices working on implementing care coordination.
Putting Theory into Practice is a resource guide that identifies organizations offering patient-centered medical home, or PCMH, support services. The guide includes a description of an organization's product or service and its geographic scope, staff qualifications and references. The guide also contains a bibliography of publications and articles that describe PCMH transformation studies, processes and outcomes.
For example, noted Abrams, Group Health Cooperative of Puget Sound in Seattle experienced a 29 percent reduction in ER visits and an 11 percent reduction in ambulatory care- sensitive admissions among its medical home patients. Abrams also pointed out that Geisinger Health System in Pennsylvania has registered an 18 percent reduction in all-cause hospital admissions, a 22 percent improvement in coronary artery disease care, and a 34.5 percent improvement in diabetes care.
Meanwhile, Blue Cross Blue Shield of Michigan, or BCBSM, has a medical home initiative that includes 774 practices and 2,614 primary care physicians who provide care to 820,000 patients. In 2010 and 2011, the BCBSM medical home registered a 9.9 percent reduction in adult ER visits compared with a 6.6 percent reduction among adult patients in non-PCMH practices, said Abrams.
The BCBSM medical home program also reported a 13.2 percent reduction in pediatric ER visits compared with an 8.8 percent reduction among pediatric patients in non-PCMH practices. During the same period, there was a 22 percent reduction in adult ambulatory care-sensitive inpatient discharges among BCBSM medical home patients compared with an 11.1 percent reduction among adult patients in non-PCMH practices, according to Abrams.
Abrams also talked briefly about PCMH initiatives that are moving forward in both the public and private sectors, including PCMH projects within the Veterans Health Administration, TRICARE and the Bureau of Primary Health Care.
"There are 41 state Medicaid programs that are in the process of planning or launching medical home programs for low-income beneficiaries," said Abrams. "This does not include the hundreds of health plans that are also working on this," she added. "The spread is substantial. We are in a very different place than we were five years ago."
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