PCMH Model Improves Care, Say Speakers, Pointing to Outcomes Data

In the five years it has existed, the Patient-Centered Primary Care Collaborative, or PCPCC, has worked assiduously to promote the patient-centered medical home, or PCMH, model of care. Those efforts were rewarded during the PCPCC's recent meeting here, when speakers presented outcomes data that demonstrate improved quality, greater patient access and lower costs in PCMH pilot projects.

"If anyone still has a question of whether the patient-centered medical home improves clinical care, the answer is a resounding yes," said David Hanekom, M.D., vice president of medical management and chief medical officer for Blue Cross Blue Shield of North Dakota, or BCBCND. Not only does the PCMH model improve the quality of lives of patients, there is empirical data to support that, he said.

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)."

During the PCPCC meeting, Hanekom presented outcomes data from MediQHome, including data that indicate blood pressure control among the 30,298 patients with type 2 diabetes in the system had grown from 74 percent to 79 percent during a three-year period, and LDL cholesterol levels of less than 100 had grown from 58 percent to 64 percent during that period. At the same time, MediQHome registered a 64.3 percent increase among patients with diabetes who had achieved optimal diabetes care.

"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.

"We see a similar pattern -- reductions in emergency department visits, reductions in ambulatory care-sensitive admissions," said Abrams, commenting on medical home initiatives monitored by the PCPCC. "We have also seen improvements in quality and increases in efficiencies."

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."