January 2014 Newsletter

The Patient-Centered Medical Home: What's In It for You?


According to a new report published by Patient-Centered Primary Care Collaborative (PCPCC), momentum for the PCMH continues to build.

The report notes that more than 90 health plans are leading PCMH initiatives, dozens of the nation's largest employers are offering advanced primary care and PCMH benefits, and millions of Medicare and Medicaid beneficiaries, military members, veterans, and federal employees are receiving PCMH care under public-sector programs.


The report further summarizes numerous favorable results from 20 PCMH studies published between August 2012 and December 2013. The studies continue to document impressive improvements across a broad range of measures including: cost, utilization, population health, prevention, access to care, and patient satisfaction.


For primary care practices, these financial and quality results bolster the imperative to "get in the game" so to speak. Practices that are unprepared to manage their patient population according to the PCMH model may fall behind on a variety of quality indicators and may miss out on practice-sustaining opportunities.


Increasingly, both private- and public-sector payers of health care are incorporating the PCMH and its key attributes into their standard payment plans. In Pennsylvania, Highmark, Independence Blue Cross, Geisinger, and UPMC Health Plan have all integrated the PCMH into new or revised pay-for-value payment designs. Meanwhile, Aetna is rolling out a national PCMH incentive program that has yet to reach Pennsylvania.


At the same time, practices that become PCMHs are well positioned to participate in Accountable Care Organizations (ACOs). Initial evaluation results from Medicare's ACO demonstration programs suggests that ACOs can contain costs and yield shared savings for their participating providers. Practices acting on their own outside of an organized ACO model may not have sufficient numbers of patients or ability to affect patient care across the medical neighborhood to attain shared savings.


For information on how to begin or advance your PCMH journey, check out the resources on the PA SPREAD website.

5 Steps to Build The Advanced Medical Home 

The Advisory Board Company recently released a Research Brief focused on the advanced medical home. There has been a 300% increase in the number of medical homes in the past 3 years alone. The PCMH is essential to managing the health of an entire population. Here are some strategies to take your medical home to the next level:


1. Reevaluate care team tasks.

2. Elevate the medical assistant to a central care team role.

3. Help physicians prioritize patient interventions.

4. Capture data and educate patients when they're waiting.

5. Incorporate group education and caregiver support into the patient visit.

Online Videos Offer Teaching on the PCMH 

Healthshare TV offers an extensive library of videos related to PCMH.


Recent additions include a 14 minute video on high-performing care coordination in the PCMH, a recent airing of a Pennsylvania  Newsmakers segment on the PCMH with Highmark's Senior Medical Director Andrew Bloschichak, MD, and Paul Conslato, MD, from Lancaster General Health, and how PCMHs can use mobile and social technologies to accelerate health behavior change.


Videos also are available on accountable care organizations, care management, meaningful use, value-based payments, and more.

Video content is free and may be a valuable resource to meet your PCMH development and staff training needs.

Best Practices Spotlight


Medical Assistants: Your Practices' Secret Weapon

Medical Assistants (MAs) are the underdogs of primary care practices. As there is no standard training or certifications for MAs, each individual should be evaluated for their own personal strengths and potential development. For instance, MAs can:

Implement standing orders to automatically provide needed services, such as immunizations, flu shots, screening tests, etc.

Serve as a health coach and help patients set self-management goals.

Run lists of patients overdue for services and call them to schedule follow-up visits.  
In The Literature 
Implementing Effective Care Management in the Patient-Centered Medical Home

A study of PCMHs in South East PA identified best practices in implementing practice-based care management. Care managers from the most-improved practices were found to perform more patient-centered duties, more effectively use their electronic medical records and other electronic capabilities, and were more strongly integrated into the practice team.  


These finding are timely, with interest growing in how best to implement care management in the PCMH. The findings have piqued interest in online PCMH communities and were well received at a recent conference of the North American Primary Care Research Group.


Strategies for Achieving Whole-Practice Engagement and Buy-in to the Patient-Centered Medical Home 


We all know change can be difficult. This paper presents 13 strategies used in primary care offices working to become PCMHs to achieve buy-in for change. The 13 strategies are reflected in three overarching lessons that facilitate practice buy-in: 


1. Ensure clear, concise communication and support from accessible practice leadership.


2. Effectively use internal and external resources to facilitate change.


3.Create a team environment that encourages ownership, accountability, support, and confidence.

Join Our Mailing List