New Health Care Model Pays for Quality

Under this new approach, patients are at the center of the health care experience

Published: Sunday, August 16, 2009 - 17:45

The “Patient-Centered Medical Home” (PCMH) is the latest in health care quality initiatives. In a PCMH, a medical team—led by a patient’s primary physician—continuously coordinates and manages the patient’s health care throughout their life. The transition is being led by the promise of paying physicians for the quality of the care they give rather than the number of patients they treat.

Health care providers across the country are slowly transitioning their practices into PCMHs. In the pilot program in Arizona, supported by IBM and sponsored by health insurance provider United Healthcare, several primary care practices in Phoenix and Tucson have turned into PCMHs, and Blue Cross Blue Shield is doing the same in Michigan. Johns Hopkins and the American Academy of Family Physicians have already created an online Continuing Medical Education course for physicians to help their transform their primary care practices into PCMH systems. 

IBM, a large employer in Arizona, is closely involved with PCMH and encourages its employers in the area to seek care with physicians who are participating in the pilot program. The program is intended to increase access to care, improve quality and better manage costs, according to Will Shanley, director of public relations at United Healthcare.

"The response so far has been very positive. We are six months into the pilot and all seven of the participating physicians offices have taken the necessary steps to become medical homes. Patients are also starting to experience these changes, including more flexible scheduling and better coordination of care. Those structural changes have a real and tangible affect on the care patients receive. This pilot is a win-win-win for patients, physicians, and the health care system," Shanley says.

Broken down, PCMH works as follow:

• Patients are registered in their primary care giver's practice.

• Any necessary care is determined by using a “proactive health plan” that may or may not require frequent physician visits.

• The nature of the care given is based on standard guidelines.

• Physician quality is constantly measured and improved.

• Patients receive a health care team to administer and monitor care.

• Various health care professionals operating at the “top of their licenses” serve patients.

Insurers such as IBM assert that current medical treatment focuses on fixing a patient’s problem rather than taking the appropriate measures to prevent it from happening in the first place. Today’s treatment favors a relationship between doctor and patient where the patient takes a passive role in their health care as the doctor examines, treats, and diagnosis them. Under the PCMH model, the relationship between physician and patient is built on communication and emphasizes patient education so that the patient may take more active role in their health care and in maintaining their personal well-being.

The primary physician serves as the home office where the patient can direct all of their medical needs.

Primary physicians partaking in the PCMH system will be required to make some compromises when it comes to administering care but they will benefit from the transition as well. By becoming manager of their patients they are open to greater reimbursement from the insurers promoting PCMH care.

"What we can say is that physicians offices involved with the medical home pilot must take on additional responsibilities, including expanding their care coordination. While this process requires additional work and investment, United Healthcare believes the improved patient care is a fantastic reward and will better manage costs over time," adds Shanley.

This new initiative also aims to take some of the financial burden from those eligible, through their service provider, to participate. Insurers like IBM and United Healthcare believe that this initiative will lead to a reduction in health care costs for everyone involved. By focusing on regular, continuous care from one primary physician and his or her team rather than seeking care sporadically from various health professionals, the number of extra services required, such as hospital visits, should significantly decrease.

According to the Center for Evaluative Clinical Sciences at Dartmouth, the states that currently rely on primary care, more than any other form of care, have less required Medicare spending, a smaller amount of necessary resources beyond those provided by primary care, and a better quality of care overall. It would make sense for PCMH to achieve all of these same benefits since the focus is on primary care.

About The Author

Brittany Vogel

Brittany Vogel is a reporter and editor for Quality Digest.