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Wednesday, March 20, 2013

Medical Home Summit takes the temperature of the PCMH

Last week, the Fifth Annual Medical Home Summit was held in Philadelphia, attracting more than 300 physicians, practice managers and other industry members to discuss the current state of practices moving to the patient-centered medical home (PCMH) model.

The model is no longer an experiment, with conference co-chair Marci Nielsen, CEO of the Patient-Centered Primary Care Collaborative, saying that more than 4,600 sites and 8,300 clinicians were recognized as medical homes in 2012 by the National Committee for Quality Assurance (NCQA), up from just 28 sites and 214 clinicians in 2008.

Much of the discussion was on the many paths organizations across the country are taking to become medical homes and use that structure to improve patient care and patient experience and control health care costs.

Here are five key themes that emerged during the four-day conference:

1. Patients and their families are a key resource in designing how your medical home is built and how to measure its success. Several speakers recommended establishing patient advisory panels so you can make sure that how you provide care and outreach services matches what patients actually want. Also, asking patients' families how they evaluate their health care experience is helpful instead of relying on purely clinical data or process information. Said one presenter, "We often ask things they don't care about."

2. Going hand-in-hand with that involvement is the need to make patients more responsible for their own care, presenters said. That doesn't mean giving up your clinical expertise but instead truly making them part of the team and helping them realize they're not just consumers of health care but "experts" on their own health care needs. Presenters said this involves finding ways to give patients a "voice" in their care that they didn't know they had, but it also will require retraining physicians, nurses, and other providers who were likely not taught non-medical collaboration skills in school.

3. Technology is both an accelerant and a damper on the true opportunity of a medical home. Electronic health records (EHRs), with the ability to help physicians parse their patient panel and identify the sickest individuals or those needing better care coordination, could help make medical homes far more targeted and effective in reducing unnecessary care and cost. But several physicians also complained that many EHRs simply aren't flexible enough to support the wide variety of operational and financial quirks physicians can build into their medical homes and that EHRs lack the interoperability to adequately share data between providers. More technology advancement is needed, they said.

4. Medical homes will continue to rely a great deal on non-physician providers. In fact, several speakers said that how doctors include registered nurses, licensed vocational nurses, physician assistants, medical assistants, and a patchwork of "community care teams," "patient navigators," and "pre-visit planners" in their medical homes' operation will determine if their efforts are successful. That's because medical homes are supposed to create efficiency, they said, letting the physician focus on the sickest patients and letting the rest of the team handle the day-to-day care coordination that will ultimately keep patients out of the doctor's office or hospital. For more information on the roles of medical assistants in medical homes, see this recent Family Practice Management article.

One of the meeting's bigger moments was during a presentation by Camden, N.J., physician Jeffrey Brenner, MD, who suggested that health care groups that don't do a better job of coordinating routine care through their physician offices could find themselves upended and put out of business by nurse practitioners doing many of those preventive procedures themselves. In fact, he compared nurses with the advent of Netflix and other "disruptive" market forces that ultimately reshaped entire industries.

5. Everything still hinges on getting paid. As speakers discussed their own practice designs, complexity of patient panels, and relative success in improving patient outcomes, many returned to the question of when commercial payers or their state Medicaid programs might recognize and pay for the medical home approach. The National Academy of State Health Policy saying that 28 states now have some form of PCMH payment, and the consensus was that most major insurance companies are increasing their interest in the potential benefits of the medical home approach and that "shared savings" – where the provider and the insurer split any savings on the cost of care – is an emerging payment model. Presenters said creating payment schemes where physicians aren't in danger of making less than a certain amount per patient because of "shared risk" (although still able to receive bonuses for improved quality) provides the best chance of motivating physicians to form a medical home.

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