Recent enactment of health care reform legislation will accelerate the adoption of the patient-centered medical home, or PCMH, in the public and private sectors by making key investments in the nation's primary care infrastructure while also giving CMS greater latitude in launching and sustaining innovative models, which then may be implemented by the private sector. That's according to two keynote speakers who addressed the Patient-Centered Primary Care Collaborative, or PCPCC, stakeholders' meeting here on July 22.
The Patient Protection and Affordable Care Act has "expanded the portfolio investment in CMS in terms of Medicare and Medicaid innovation," which will give that agency much more latitude in developing payment and service delivery models that reduce costs and improve quality, said Anthony Rodgers, M.S.P.H., deputy administrator for the Center for Strategic Planning and Initiatives at CMS and one of two keynote speakers to address the conference.
At the same time, the legislation substantially increased funding for the National Health Service Corps, or NHSC, and community health centers, or CHCs, for the next few years. It also provides funds to expand the number of primary care residency slots in community settings in an effort to train 500 additional primary care physicians by 2015.
These types of investments represent support and an underlying commitment to primary care and the PCMH, said Mary Wakefield, R.N., Ph.D., administrator at the Health Resources and Services Administration, or HRSA, and the other keynote speaker to address the conference.
During the July 22 stakeholder's conference of the Patient-Centered Primary Care Collaborative, Therese Helle, manager of health care quality and efficiency initiatives for the Boeing Co., shared the aircraft manufacturer's experiences with a medical home pilot project(healthaffairs.org) it launched in the Seattle and Puget Sound region in 2007.
The project involved three large medical groups and covered 740 patients who were considered medically complex because they had an average of four different medical conditions, said Helle.
She noted that the pilot, which ran for two-and-a-half years, reduced emergency room visits and hospital admissions among Boeing employees. This led, in turn, to a 20 percent net savings in medical costs among patients in the medical home. The project also led to increased employee and physician satisfaction rates, and it reduced the number of days employees missed because of illnesses, according to Helle.
"We need our employees healthy and productive at work," she said. "Right now, we have about 3,500 commercial airplanes in the pipeline that need to be built."
The Patient Protection and Affordable Care Act calls for the establishment of a Center for Medicare and Medicaid Innovation, or CMI, on Jan. 1, 2011. The legislation gives the CMI the authority to launch pilot projects without first demonstrating that projects will achieve budget neutrality.
In the past, CMS had to demonstrate that it would not spend more money for a particular pilot project than it otherwise would have spent before it could launch a project.
The health care reform act also eliminates a stipulation that required many demonstration projects to last five years. This makes it possible for CMS to shorten the time for a demonstration and, thus, to "test models at different levels," said Rodgers.
"We don't have to have large demonstrations," he noted. "We can test at a prototype level. That is going to allow us to take existing models, optimize them (and) test what it takes to bring them to full maturity to derive that information into our policy settings and into how we reimburse in the future."
The CMI also likely would bring together various stakeholders -- such as private insurers and business leaders -- to collaborate on demonstration projects, said Rodgers.
"Innovation is messy," he said. "There are failures and there are successes, and we want to learn from both. At the end of the day it has to be collaborative." Having stakeholders at the table also means CMS would be able to spread innovation more rapidly.
Rodgers said the focus of the CMI will be to "build upon the current foundation of medical homes and health care homes." Primary care medical homes will be the "vanguard of the future of community health," he added.
The basic medical home model offers better coordination of care and patient care management, said Rodgers. "But we quickly have to move to more advanced medical homes that have the ability to manage acute and chronic care across the continuum of care."
During her comments, Wakefield noted that the combination of the health care reform legislation and the American Recovery and Reinvestment Act of 2009, or ARRA, represents the most significant expansion of primary care in recent memory from HRSA's perspective.
She pointed out that the ARRA provides $300 million for the NHSC and $200 million for primary care and other health care professionals trained through Titles VII and VIII of the Public Health Service Act.
In addition, the health care reform legislation will provide another $1.5 billion in dedicated funding for the NHSC from 2011 to 2015 and $11 billion for CHCs during the next five years.
Access to health care "is very much about access to health insurance coverage," said Wakefield. However, she added, access to health care also depends on the availability of a team of highly qualified health care professionals.
She called for a primary care workforce that is "adequate in number, adequate in distribution and adequate in competencies in order to deliver on this (medical home) care model."
"I want to be clear that President (Obama) going forward and everyone at HRSA understands the importance of addressing this deferred issue -- that is a focus on primary care and a focus on building a platform of health care providers," she said.