PCPCC Executive Director Lays Out Collaborative's Goals

When the Patient-Centered Primary Care Collaborative, or PCPCC, began two years ago, it consisted of the AAFP, several other physician-led organizations and a few large employers. During the past few years, however, the collaborative has experienced explosive growth, swelling to more than 500 members who represent nearly every segment of society.

PCPCC members have coalesced around the principles of the patient-centered medical home, or PCMH, and each member is committed to the enactment of health care reform that encompasses the PCMH and primary care as a centerpiece of the nation's health care system.

During the past two years, the collaborative has emerged as a major player in the ongoing debate about health care reform. It has become a catalyst for efforts to enact primary care and PCMH legislation at the state and federal levels.

Edwina Rogers, J.D., is executive director of the PCPCC. She has been a public policy expert for more than 20 years, and was an economic adviser for President George W. Bush. She also worked on international trade matters for the first President Bush at the Department of Commerce. AAFP News Now recently sat down with Rogers to talk about the goals of the PCPCC and how far the collaborative has come.

Q. What is the main goal of the Patient-Centered Primary Care Collaborative?

A. The bottom line is we want to make sure every American has a patient centered-medical home.

Q. Why is that so important?

A. With health care reform, there is a short list of consensus items that have developed in Washington. We know we want to get every American into the health care system, and we also know that primary care has tremendous benefits and should be a major focus with regard to health care reform. In addition, the PCMH is the optimum delivery system for other "short-list" consensus items, such as prevention, wellness and the whole health information technology piece.

Q. Why is there a need for a collaborative built around the PCMH?

A. You need a collaborative to get to every American. We need public/private partnerships. All the separate state Medicaid and Children’s Health Insurance Programs have to go through transformation. The federal government has to go through transformation -- in particular Medicare, federal employees, the Department of Defense, the Department of Veterans Affairs. Then you have the whole private sector, all the employers, their health care plans and, of course, the payers -- the health insurance companies. The collaborative enables us to reach out to everyone in the United States who is relevant and who has some basic policies and procedures and guidelines so that we know what it is we are talking about and that there is a common theme among what it is we are trying to do.

Q. Where is the collaborative in terms of progress?

A. We are three years into the collaborative. We are past the organizational phase, and we are in the implementation phase at this point. We have more than 500 entities that have signed up to participate in the collaborative. We have 22 fairly large multistakeholder demonstration projects going on around the United States -- several are statewide and include everyone in the state with the exception of Medicare beneficiaries. We have about 330 laws and regulations that have passed during the past two years that require Medicaid, the State Children’s Health Insurance Program, or county or state employee programs to incorporate the PCMH. We also have the Medicare demonstration rollout that will be unveiled any day now.

Q. Congress created a three-year medical home demonstration project as part of the Tax Relief and Health Care Act of 2006. The project will be conducted in eight states and will involve about 400 practices, 2,000 physicians and 400,000 Medicare beneficiaries. CMS was supposed to launch the project by the end of last year, but it has not been implemented yet. Are you frustrated that the project has not started?

A. No, not really, because they were hoping to have it ready by January. But once CMS put together the whole program and got it to the Office of Management and Budget (OMB), it was already October or November. Then we had the change in the administration, and then we had all of this stimulus money. The only delay right now -- what we are being told by White House officials and OMB folks -- is they are trying to marry up all of the health IT (information technology) stimulus money with the PCMH demonstration project in Medicare to make sure there is no duplication and that they work very well together.

Q. Is the PCMH being driven more by the private or public sector?

A. My sense is the public sector has gotten out in front of the private sector for a change. It was initially pushed primarily by the private sector -- major employers who have employees in nearly every major zip code in the United States and nearly every country in the world. Those employers noticed that in other countries where there is a strong primary care system in place and, in particular, patient-centered medical homes, those countries' health quality outcomes are much higher, their costs are lower and patient satisfaction rates are much higher.

The public sector has really rolled with it, however, especially state Medicaid programs. Medicaid directors have been surveyed for the past four years, and number one on their wish list -- what they would rather have more than anything -- is the patient-centered medical home.

Q. The PCPCC has gone through tremendous growth during the past few years, increasing from a handful of members to more than 500 members. Is there a chance you are growing too fast and are getting ahead of yourselves?

A. I have gotten comments from a few senators along the lines of, 'This is great, we are all for it, this is motherhood and apple pie. But, we need to lower the expectations because people think it is going to solve global warming and is the answer to world peace.' So the expectations are very high.

Q. Why has the growth of the PCPCC been so explosive?

A. I would attribute it to the purity of the model and all of the evidence and the research that is backing up the benefits of primary care and what is included in the model -- the access piece for the patient, the patient feedback piece, the patient engagement piece. It is extremely popular with consumer and patient advocacy groups. There are major components within the PCMH, and each one within itself has proven to improve outcomes. But when you put all of them together, you have quite the formula for success.

Q. What does all of this mean for family and primary care physicians out in practice?

A. For the physician, I think it is a morale boosting. It is very encouraging for them to know that it is just a matter of time until they can practice medicine as they had always hoped and planned to practice medicine and that they will be paid to do exactly what they should be doing. They will be paid to keep people healthy and for the outcomes and not just for an office visit. They will be paid to look after patients and think about them when patients are not in the office.

Q. How far off is that day?

A. It is already here for physicians who are in the medical home demonstration projects. Physicians participating in these demonstration projects have addressed PCPCC conferences and have talked about the job satisfaction rates going up tremendously. They bring in their patients who talk about how the PCMH has improved their lives overall -- especially the access piece, having their care coordinated and feeling good about their care and their personal relationship with their personal physician.

Q. What have been the greatest successes of the PCPCC thus far?

A. We were able to get organized early and articulate. The Joint Principles of the Patient-Centered Medical Home (3-page PDF; About PDFs) came out. The payment model. We were able to get to the major candidates during the presidential primaries and the general election. And we were able to get the PCMH included in the Republican and Democratic health care proposals.

We had a huge success last summer in the language that was included in the physician payment update bill. That language gives the HHS secretary the authority to expand the CMS medical home demonstration pilot project if it results in lower costs or improved outcomes. Basically, we don't have to wait for the three-demonstration project to run its course and then go back to Congress and ask for the implementation of the project on a permanent basis. The HHS secretary could implement this overnight throughout the Medicare program if it is deemed successful.

Q. What impact have you had on the health care debate?

A. I think we have had tremendous impact. Sen. Max Baucus, D-Mont., chair of the Senate Finance Committee, released a white paper on health care reform in November that had several pages describing the benefits of primary care and two full pages describing the benefits of the PCMH. The Senate Finance Committee released a document on reform of the health care delivery system in late April that also referred favorably to the PCMH.

We have had countless meetings with congressional staffers on the finance committee and all of the relevant House committees. We've had Capitol Hill briefings. The first year, we did three or four major briefings up on the Hill to get the base knowledge in place.

The relevant House and Senate committees have been coming to us and asking us for advice, and they will say things like, 'We like the patient-centered medical home. We think it is a really good delivery system for health care reform. Let's talk about everything underneath that umbrella that we can help with, like, for example, the workforce issue. We can help with that. Let's brainstorm and come up with ideas and recommendations.'

Q. How do you reach out to physicians who don't want their practices to be medical homes or simply say they don't want to go through the process of becoming a PCMH?

A. We have some naysayers. I speak to them all the time. We explain the benefits of being a medical home and provide them with examples of patient-centered medical homes. We try to partner them up with similar physicians. If it is a small practice, we find a sister small practice for them to talk to so they can learn how that practice went through the transformation process. I think eventually there will be enough demand.

Q. How does the collaborative respond to subspecialists who want their practices to be medical homes?

A. The PCPCC is basically Switzerland. If there is a specialty physician group or a particular (sub)specialist physician and they think this is how they want to spend their time, they have adequate training, they have the credentials, they are offering the full spectrum and they have National Committee for Quality Assurance recognition, then by all means, they are invited to participate.

Q. The AAFP has put together a PCMH section on its Web site to help practices with the transformation process. How will that correlate with what you are doing?

A. It will correlate perfectly in that we will not try to reinvent the wheel. We have a lot of links on our Web site. Our site is considered the national resource center on the whole spectrum of the issue. We have an employer section; we have a public payer section. We are working on a transformation section, and within that section, we are going to link to TransforMED. We are talking to them right now to work out the link.

Q. Where will the collaborative be five or 10 years from now?

A. The leadership of the collaborative went through strategic planning last September, and we calculated that it is going to take five to seven years to have full implementation to make sure every American has a PCMH. We are planning a big victory party when that happens, and then we are going to shut down and go home.