PCPCC Summit Highlights Growing Support for Patient-Centered Medical Home

As more demonstration projects prove the value of the patient-centered medical home, or PCMH, in increasing care efficacy and reducing costs, a number of federal agencies are adopting the medical home model as part of their overall health care transformation efforts. That was one of the messages that came out of the Patient-Centered Primary Care Collaborative, or PCPCC, summit here on Oct. 22.

Robert Kocher, M.D., a member of the National Economic Council and special assistant for health care to President Obama, said mounting evidence is "unequivocal" in showing that if done right, medical homes are more cost-effective than traditional models of care and improve patient outcomes. "We see (PCMHs) as not only a better way to take care of patients, but a better way to create value," said Kocher during a panel presentation. "This model avoids complications, avoids hospitalizations and helps patients live better."

Kocher cited data published by the PCPCC (92-page PDF; About PDFs) that show dramatic results for health care systems that have implemented the PCMH. For example, the Group Health Cooperative, a consumer-owned integrated delivery system in the Northwest, piloted a PCMH redesign at one of its clinic sites in Seattle in 2007. During a one-year period, the clinic recorded a 29 percent reduction in emergency room visits and an 11 percent reduction in ambulatory sensitive care admissions.

The Geisinger Health System, an integrated delivery system in Pennsylvania, implemented a PCMH redesign in 11 of its primary care practices in 2007, focusing on Medicare beneficiaries and emphasizing care coordination within a team model. During a 24-month period, the redesigned practices registered a 14 percent reduction in total hospital admissions compared with other practices in the system and a nearly 9 percent reduction in total medical costs.

Kocher mentioned medical home models in other states that have achieved similar results in improving patient outcomes and lowering costs. More than 40 states have launched some type of medical home pilot project, he said.

Kocher also pointed to a new medical home project launched by CMS in which Medicare will join with Medicaid and private insurers in state-based efforts to improve the way care is delivered using the medical home model. The demonstration builds on a PCMH that is being tested in Vermont in which private insurers are working in tandem with Medicaid to set uniform standards for PCMHs.

In addition, CMS is working to launch a medical home demonstration project (3-page PDF; About PDFs) for Medicare patients that will take place in eight states. The new project will begin in January and last for three years. It seeks to coordinate health care delivery through a patient-centered team approach while emphasizing prevention, health information technology, care coordination and shared decision-making among patients and their physicians.

Other federal agencies are following CMS' lead. For example, the secretary of the U.S. Department of Veterans Affairs recently ordered the Veterans Health Administration, or VHA, to transform that system, said Joanne Shear, M.S., FNP-BC, national clinical program manager for primary care at the department's central office in Washington. "And that means transforming our entire system of primary care into a medical home model," said Shear, who pointed out that the VHA is the largest integrated health care system in the country.

In the meantime, the assistant secretary of defense for health affairs has issued a memorandum stating that the PCMH will be the model of care for the Army, Navy and Air Force, said Cmdr. Kevin Dorrance, M.D., assistant chief of medicine and department head of internal medicine at the National Naval Medical Center.

"We are moving forward in pushing this model as quickly as we can," said Dorrance.

Rep. Allyson Schwartz, D-Pa., who delivered the keynote address at the PCPCC summit, said she is "particularly proud of the renewed focus on primary care and the interest in primary care coverage and expansion."

Schwartz, sponsor of the Preserving Patient Access to Primary Care Act, (at the THOMAS Web site, type "H.R. 2350" into the search field after selecting "Bill Number") said that primary care and the PCMH are the "cornerstones to really moving ahead with a new focus in how health care is delivered in this country."

In a brief interview with AAFP News Now, she also noted that a PCMH provision likely would be part of any comprehensive health care reform bill passed by Congress. According to Schwartz, the House and Senate health care reform bills include PCMH provisions, making it highly likely that Congress will pass a PCMH measure as part of health care reform.