Posts Tagged ‘Patient-Centered Medical Home’

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CCMI’s Primary Care Initiatives Produce Modest, Mixed Results

February 8th, 2018 by Melanie Matthews

Comprehensive Primary Care Initiative Analysis

Comprehensive Primary Care Initiative Analysis: Mixed, Modest Results

The Center for Medicare & Medicaid Innovation’s (CCMI) Primary Care Initiatives have produced modest and mixed results, according to a final review of the program conducted by Kennell and Associates, Inc. and RTI International and released by CMS.

The six CMMI initiatives included in the review are the Comprehensive Primary Care (CPC) initiative, the Federally Qualified Health Center (FQHC) Advanced Primacy Care Practice demonstration, the Independence at Home (IAH) demonstration, the Multi-Payer Advanced Primary Care Practice (MAPCP) Demonstration, the State Innovation Models (SIM) initiative, and the Health Care Innovation Awards Primary Care Redesign Programs (HCIA-PCR), which CMS identified as the most focused on primary care redesign.

Initiative practices did make large strides toward becoming Patient-Centered Medical Homes (PCMHs) or advanced primary care practices. While less than 10 percent of initiative FQHCs had any PCMH recognition status prior to the initiative, 70 percent achieved NCQA Level-3 recognition by the end of the initiative. Similarly, the CPC evaluation found that CPC initiative practices improved their PCMH Assessment scores by about 50 percent.

While the review did not find consistent impacts across the initiatives or by setting within initiatives for any of the four core outcomes identified by CMS: fee-for-service Medicare hospital admissions, 30-day readmissions, outpatient ED visits, and Medicare expenditures, some of the initiatives did report some positive outcomes.

Of the 22 more granular initiative settings (seven CPC regions, FQHC as a whole, six HCIA-PCR awardees, and eight MAPCP states) for which cumulative results through Year 3 were available, 10 settings experienced improvement relative to their comparison group for at least one of the four core outcome measures at a significance level and three of these settings (two CPC regions and HCIA TransforMED) experienced improvement on at least two core outcomes.

Across four initiatives (CPC, MAPCP, HCIA-PCR, and FQHC), analyses indicated that the aggregate impacts on the core outcomes were small and not statistically significant.

Certain population subgroups and practice types across initiatives experienced more favorable outcomes, according to the analysis. Specifically, beneficiaries originally eligible for Medicare due to disability and beneficiaries with poor health (highest quartile of baseline HCC risk scores) experienced slower growth in Medicare expenditures. However, disability status and HCC risk score were not associated with statically significant impacts on overall rates of hospitalizations or ED visits, and non-dually eligible beneficiaries and those who were not originally eligible for Medicare due to disability experienced lower rates of 30-day readmissions.

The analysis also found slower growth in Medicare expenditures and lower rates of inpatient admissions and ED visits among practices with fewer than six practitioners and also among practices that were not multispecialty practices.

Other key findings from the analysis:

  • There are advantages to both state-convened and CMS-convened initiatives;
  • Practice-level factors are important in addressing transformation challenges; and
  • Initiative-level supports also helped practices meet transformation challenges.

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Posted in Healthcare Trends, Hospital Readmissions, Medicaid, Medicare, Patient-Centered Medical Home, Primary Care Practice | Comments Off on CCMI’s Primary Care Initiatives Produce Modest, Mixed Results

Infographic: Community Health Centers Transform to Medical Homes

November 20th, 2015 by Melanie Matthews

Community health centers provide essential health services to all patients, even those uninsured or unable to pay. When these centers operate as patient-centered medical homes, they can care for patients more efficiently and effectively.

A new infographic by the Commonwealth Fund looks at some of the key characteristics of a patient-centered medical home and the growth of community health centers now operating as medical homes from 2009 to 2013.

Having established a firm foundation over two decades of patient-centered care, the medical home model is poised for a makeover, expanding to medical neighborhoods and opening the door to specialists’ enhanced role in care coordination—while embracing value-based compensation models that reward quality over quantity.

Those are just two of the trends explored in 2014 Healthcare Benchmarks: The Patient-Centered Medical Home, the Healthcare Intelligence Network’s in-depth analysis of medical home adoption, tools, technologies, challenges, benefits and outcomes.

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8 Effective PCMH Tools to Protect the Medical Home Investment

March 19th, 2015 by Cheryl Miller

The patient-centered medical home (PCMH) model is one of the top five investments in 2015, according to Accenture’s recent analysis of government-sponsored State Health Innovation Plans. Researchers from Accenture found that states are investing in PCMHs in order to strengthen primary care integration with specialists and community health workers. Most will also integrate physical and behavioral care.

Embedding care coordinators in physician offices so they can work with case managers is one way to achieve this integration, according to respondents to the seventh comprehensive Patient-Centered Medical Home (PCMH) survey by the Healthcare Intelligence Network (HIN). We asked survey respondents what other tools they felt were most effective in implementing the medical home. Following are their responses:

  • Electronic communications that include actionable data and access to patients to initiate the change, and a focus on minimal hassle to physician office.
  • The NCQA PCMH tool.
  • Pre-visit planning and ‘huddles.’
  • Patient registries.
  • Monitoring. We fundamentally changed how we operate daily and monitor change. We incorporated our goal measures into the very fabric of what we do.
  • Using templates in electronic medical records (EMRs) for pre-visit planning and coordination of relevant visits.
  • Home care nurse management system.
  • Patient-centered scheduling.

Source: 2014 Healthcare Benchmarks: The Patient-Centered Medical Home

http://hin.3dcartstores.com/Remote-Monitoring-of-High-Risk-Patients-Telehealth-Protocols-for-Chronic-Care-Management_p_5008.html

2014 Healthcare Benchmarks: The Patient-Centered Medical Home is the Healthcare Intelligence Network’s in-depth analysis of medical home adoption, tools, technologies, challenges, benefits and outcomes. Based on HIN’s PCMH survey administered in February 2014, this resource takes the industry’s pulse on patient-centered activity. Now in its seventh year, it is designed to meet business and planning needs of physician practices, clinics, health plans, managed care organizations, hospitals and others by providing critical benchmarks in medical home implementation and results.

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Posted in Affordable Care Act, Behavioral Health, Bundled Payments, Care Coordination, Care Management, Case Management, Chronic Care Management, Disease Management, Healthcare Reform, Patient-Centered Medical Home | Comments Off on 8 Effective PCMH Tools to Protect the Medical Home Investment

Infographic: State Health Innovation Plans

February 2nd, 2015 by Melanie Matthews

An analysis of state health innovation plans illustrates that states are moving toward patient-centered healthcare, according to a new report and infographic by Accenture.

The infographic examines the necessary infrastructure needed to surround the patient and the progress states are making on these elements.

2014 Healthcare Benchmarks: The Patient-Centered Medical HomeHaving established a firm foundation over two decades of patient-centered care, the medical home model is poised for a makeover, expanding to medical neighborhoods and opening the door to specialists’ enhanced role in care coordination—while embracing value-based compensation models that reward quality over quantity.

Those are just two of the trends explored in 2014 Healthcare Benchmarks: The Patient-Centered Medical Home, the Healthcare Intelligence Network’s in-depth analysis of medical home adoption, tools, technologies, challenges, benefits and outcomes.

Get the latest healthcare infographics delivered to your e-inbox with Eye on Infographics, a bi-weekly, e-newsletter digest of visual healthcare data. Click here to sign up today.

Have an infographic you’d like featured on our site? Click here for submission guidelines.

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5 Features of the Patient-Centered Medical Home

October 23rd, 2014 by Cheryl Miller

Patient-centered medical homes (PCMHs) are not about pigeon-holing certain diseases or illnesses, says Terry McGeeney, MD, MBA, director at BDC Advisors, but about delivering acute and chronic care prevention and wellness. Dr. McGeeney reiterated the five essential features of the medical home as the groundwork for a medical neighborhood.

Given many of the initiatives of the Centers for Medicare and Medicaid Services (CMS), coupled with the Triple Aim, many have gotten bogged down and probably overly focused on the name: patient-centered medical home (PCMH). What’s important are the features or attributes of the PCMH: first, its patient-centeredness, a partnership among practitioners, patients and their families that ensures and respects the decisions of the patients and ensures patients have the education and support they need.

Secondly, in a PCMH, the care needs to be comprehensive. It’s a team of care providers who are wholly accountable for a patient’s physical and mental healthcare needs, including prevention and wellness, acute care, and chronic care.

Third, you will hear discussions about the PCMH being about a certain disease or illness. Please note that it’s acute and chronic care prevention and wellness. Pigeon-holing conditions, while important, is more of a chronic quality improvement initiative and not PCMH.

Fourth, under the PCMH, care needs to be coordinated. Care is organized across all elements of the broader healthcare system, including specialists, hospital, home healthcare, community service and support. There’s a lot of debate now about what we call ‘post-acute care’ or ‘transitions in care.’ Jonathan Blum, principal deputy administrator of CMS, recently spoke on the importance of post-acute care. This is what coordinated care particularly is all about.

Care has to be accessible. Patients are able to access services with shorter waiting times, after-hours care with access to EHRs, etc., and there has to be a commitment to quality and safety. Clinicians and staff need to enhance quality improvement with the use of health IT and other tools that are available to them.

We also need to be very careful that quality care is not equated with lower cost of care. Sometimes those two have a tendency to get muddled.

Source: Blueprint for a Medical Neighborhood: Building Care Coordination Between Specialists and PCPs

http://hin.3dcartstores.com/Blueprint-for-a-Medical-Neighborhood-Building-Care-Coordination-Between-Specialists-and-PCPs_p_4967.html

Blueprint for a Medical Neighborhood: Building Care Coordination Between Specialists and PCPs provides a framework in which to evaluate the patient-centered medical neighborhood (PCM-N) model. Pictured here is Terry McGeeney, MD, MBA, director of BDC Advisors, who navigates the landscape of the medical neighborhood, from the value-based payment realities of healthcare today to identifying and engaging specialists in a medical home neighborhood.

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Posted in Cardiac Care, Care Coordination, Care Transitions, Disease Management, Medical Neighborhood, Medication Management, Patient-Centered Medical Home | Comments Off on 5 Features of the Patient-Centered Medical Home

8 Challenges to Medical Home Success

March 12th, 2014 by Jessica Fornarotto

“What’s important about patient-centered medical homes (PCMHs) is that they’re patient-centered. PCMHs are a partnership among practitioners, patients and their families that ensures and respects the decisions of the patients. And patients have the education and support they need,” explains Terry McGeeney, MD, MBA, director of BDC Advisors. Dr. McGeeney lists below the eight challenges in successfully changing to a PCMH.

The first challenge to PCMH success is that many physicians are reluctant to change. Physicians have been trained to be change-averse and variable-averse to avoid making mistakes at two o’clock in the morning, etc. Second, physician leadership and physician champions are critical. Sometimes this has to be trained and taught.

Next, there’s a culture that is very traditional in healthcare; we need to think and talk about that. There is also a culture within individual practices and health systems that creates barriers to successful transformation. Another challenge is that some providers are not able to function effectively in a team environment. This needs to be supported and transformed with the appropriate training provided.

The next challenge is communication, which is critical at multiple levels. Successful medical neighborhoods and clinically integrated neighborhoods (CINs) are built around communication, care plans, care that’s delivered, data, quality metrics, lab data, etc. The sixth challenge is that there has to be trust between all of the entities as systems are transforming and payor data becomes more critical. Partnerships with payors around shared savings or shared risk are becoming more common. Trust is critical and that hasn’t always existed.

Next, we need to make sure there are aligned incentives; you can’t ask people to do more work for the same compensation. You can’t ask them to assume more risk for the same compensation. Incentives need to be aligned around what is now called ‘value-proposition’ or ‘pay-for-value,’ or to where there is an expectation to improve quality and lower cost.

The final challenge is there needs to be full recognition that PCMH transformation is not easy. It’s very difficult and time consuming, but in the end it’s highly rewarding.

Excerpted from: Driving Value-Based Reimbursement with Integrated Care Models

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4 Trends for Healthcare Providers in 2014

January 30th, 2014 by Jessica Fornarotto

Dual-track medical homes, e-visits, retooled patient handoffs and more post-acute care are predicted provider trends for 2014, according to Steven Valentine, president of The Camden Group. HIN interviewed Valentine prior to his presentation during an October webinar on Healthcare Trends & Forecasts in 2014: A Strategic Planning Session.

HIN: What is the physician practice going to look like in 2014? How has the primary care team evolved to meet the Triple Aim values inherent in the PCMH and accountable care models?

(Steven Valentine): We should expect to continue to see consolidation amongst the medical groups. The independent practice associations will begin to assimilate together because they need to put more money into their infrastructure. And many of the organizations have underperformed, in all honesty.

The primary care team is still critical. We’ve benefitted by keeping many primary care doctors around because they were negatively hurt with their net worth in the recession in 2008-2010. But it’s slowly coming back and we’re starting to see those physicians thinking about retirement again. The reality is, we’re never going to replace all of these primary care doctors as they wind down their practice. We need to do a better job of getting telehealth going and utilizing e-visits. We’re seeing the health plans starting to pay for those e-visits, as well as having the consumer who uses them use a credit card and pay at that time, just like a visit.

We’re going to have to look at different models. Obviously, the nurse practitioner is getting more involved with the primary care. And yes, they’re still pursuing the Triple Aim. We know that quality scores, satisfaction scores and trying to manage cost per unit is still a critical focus of the triple aim moving forward with population health.

Lastly, with a PCMH in accountable care, while some of the pioneer accountable care organizations (ACOs) reduce themselves out of pioneer into the Medicare Shared Savings Program (MSSP), we still have a number of organizations and it’s growing. The commercial ACOs have been very successful in California.

We fully expect accountable care to continue. We think the PCMH will evolve into two tracks. The first track is a primary care PCMH. The spinoff is a chronic care medical home that has the multidisciplinary team organized around a chronic disease. This is a model developed by CareMore years ago in Southern California and it’s been expanded across the country. As I travel the country, I run into organizations that have set up these chronic care centers around the chronic disease.

HIN: Regarding the Pioneer ACO program, one of the top performers in the CMS pioneer program, Monarch HealthCare, told us that it’s going to be working to engage specialists in care coordination roles in year two and year three. What’s ahead for specialists in terms of quality and performance improvement as well as shouldering perhaps more care coordination duties, especially for Medicare patients?

(Steven Valentine): The specialists are going to be a critical piece to this whole solution. They have been a tremendous asset in the area of bundled payments, where you have the facility fee and physician fee combined into one payment. That works for both the Medicare as well as the commercial side. You’re beginning to see more of the bundled payments within an ACO.

The ACO manages what we call ‘frequency’ — in other words, the number of procedures to be done. Specialists are involved in satisfaction, quality scores, and resource consumption once the decision is made that the procedure needs to be done.

We expect the specialists to be involved with quality and performance. Everybody is putting in incentive programs to help drive higher quality, better performance, and a lower cost.

HIN: Hospitals have tightened the patient discharge process as a means of shoring up care transitions. But what other work needs to be done in terms of collaborations, perhaps with skilled nursing facilities (SNFs), long-term care and home health, for example, to improve patient handoffs and reduce hospital readmissions?

(Steven Valentine): Handoffs have probably been one of the areas where we’ve seen the most disappointment or underperformance within many ACOs. They have not effectively involved the hospitalists and the care/case managers who are typically embedded within the medical group that would oversee the patient throughout the care continuum. Or if it’s a health system, emanate centralized care/case management function where they manage all of the transitions from pre-acute, acute to post-acute. We think this will get better. As the doctors are more at risk, they will get more engaged with the care/case managers to manage these transitions and handoffs.

We also know that, while not in 2014 but the trend will start, we’ll see lower acute care utilization, pushing more patients to post-acute care. This means, in any given area, acute care hospitals will begin to convert excess capacity to post-acute care services like skilled nursing, long-term care, palliative care, hospice care, home care and rehab care. You will begin to see a closer proximity. The care managers will be able to work more effectively with the doctors and hospitals to manage the patient through the continuum, smooth out these transitions and have a better patient experience with better satisfaction scores at a lower cost.

Excerpted from: Healthcare Trends & Forecasts in 2014: Performance Expectations for the Healthcare Industry

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Posted in Accountable Care Organizations, Care Coordination, Care Transitions, Case Management, Healthcare Trends, Hospital Readmissions, Medicare, Patient-Centered Medical Home, Post-Acute Care | Comments Off on 4 Trends for Healthcare Providers in 2014

Adapting 3 NCQA Standards for the Patient-Centered Medical Home

January 24th, 2014 by Cheryl Miller

Coming from a group of innovators who had adopted EHRs early on and were not afraid of data, participants in the Hudson Valley medical home transformation project decided to concentrate on three out of nine NCQA standards: access and communication, inpatient self-management, and performance reporting, explains Paul Kaye, MD, medical director at Taconic IPA.

Let’s move on to the nine standards of NCQA. All of them are available at NCQA’s Web site. We found that we needed to concentrate primarily on the areas of access and communication, inpatient self-management and performance reporting. It’s not to say that the other pieces don’t warrant a challenge, but many of them reflected EHR use and the ability to report on that use rather than a radical transformation of practice.

Initial steps were to require all of our practices to take TransforMED’s medical home IQ self-examination. Then a practice work plan for each practice was created. There was a staff-wide kickoff with each practice. Scheduling that was a challenge for busy private practices, as well as for the community health centers. Regular contact occurred between the coaches with timetables and deliverables that were there for particular elements and standards that had to be met.

Our medical council met once a month. The council included the physician and non-physician leadership of each practice. We highlighted a different standard at each meeting, shared best practices and came to an agreement on the three conditions that one needs to identify for NCQA medical home recognition. There was agreement across the practices that diabetes was an important condition in our area and there was also agreement on adopting practice guidelines, which had already been worked on at the statewide level, so that was a non-controversial area to be able to tackle. We also had two full-day workshops called learning collaboratives, and continue to have these every six months. For these workshops, outside speakers of national prominence came to talk about the medical home and some of the changes that needed to be done.

With all those areas of success, we had no difficulty agreeing on a clinically important condition and on defining a few more to pick from. Agreement on practice guidelines again came easily because of work that had already occurred. Most of the practices found that the standards that required documentation of an EHR functionality, while challenging to document on a piece of paper, were already present and didn’t require much radical change in their practice. These are the low hanging fruit, and showing some of this early on started to build the spirit of cooperation among the providers.

Excerpted from Guide to Physician Performance-Based Reimbursement: Payoffs from Incentives, Data Sharing and Clinical Integration.

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3 2014 Trends for Health Plans

January 21st, 2014 by Jessica Fornarotto

Influencing primary care, aggregating and mining data, and embracing bundled or episode-based payments are three trends that will influence health plans in 2014, predicts Catherine Sreckovich, managing director in the healthcare practice at Navigant Consulting.

HIN interviewed Sreckovich on these trends prior to her presentation during HIN’s tenth annual webinar on Healthcare Trends & Forecasts in 2014: A Strategic Planning Session.

HIN: Where will data analytics take health plans in the coming year, and how will this shape population health management offerings?

(Catherine Sreckovich): We’re certainly hearing a lot about big data, and it will be an integral approach to merging this practice’s or population’s health, the ability to aggregate and mine data is going to be an essential capability for health plans for their predictive models. And the outputs of these models are going to enable the health plans to identify and stratify their members or population health. Member and patient demographics can also inform consumer engagement strategies to support population health. And the analytics are going to inform the effectiveness of different care management interventions and consumer engagement strategies.

HIN: Health plan case managers embedded alongside providers has become almost a de facto model. How will payors influence primary care delivery in the year to come?

(Catherine Sreckovich): There is a number of approaches evolving right now and that will continue to evolve as payors attempt to influence primary care delivery. One is the use of patient-centered medical homes (PCMHs) and other integrated models to expand the payor’s role as the primary care case manager.

In addition to paying primary care providers to hire case managers and care coordinators, payors are pushing for shared savings arrangements with these primary care providers, such as within an accountable care organization (ACO), and to push them to manage the care for those with chronic conditions.

We’re also seeing payors paying for primary care physicians to become certified PCMHs and to implement electronic health records (EHRs), either by paying directly for the certification of the technology or by adding bonus payments to their FFS rates.

Payors are also paying for incentives for primary care physicians to offer wellness programs such as smoking cessation or weight loss programs and are trying very hard to influence where and to whom primary care physicians refer their patients by giving them information about the cost and quality of other provider types, such as specialists and hospitals.

And we will continue to see that payors will target the larger primary care physician practices with whom they have a critical mass of members to achieve enough savings to offset the added costs of incentives, bonuses and shared savings arrangements. As a result, we expect that some of the smaller primary care practices will likely not receive the same level of support and push from payors.

In another example, we see payors increasingly partnering with non-traditional providers, such as retail-based clinics and community health centers to offer easily accessible primary care at lower costs. And this will certainly be an opportunity to address some of the physician supply shortages that we anticipate seeing in the next year or so as more and more people have access to healthcare insurance and coverage.

Finally, another approach payors are using is to offer members access to virtual doctor visits via webcam, for example, and other telemedicine approaches that are giving individuals access to these primary care providers to increase access to convenient and low cost primary care for their patients.

HIN: CMS and top-performing Pioneer ACOs are heavily invested in bundled or episode-based payments. Will more private payors embrace this reimbursement method as well?

(Catherine Sreckovich): Definitely. The bundled or episodic-based payment approaches are here to stay. We’re starting to see this take off in a number of states. For example, there are state innovation grants that CMS has provided to states like Arkansas, Ohio, Delaware and others looking for opportunities to implement multi-payor bundled payment initiatives. Although these are not necessarily the traditional ACO model, they built off of that ACO model.

We also see that the large health plans in various states are starting to build and develop ACOs. Key to these are the shared savings arrangements that they’re implementing with these payment approaches. So whether they’re bundled or episodic-based payments or whether they look more like a traditional ACO, if there is such a thing, we’re starting to see takeoffs on those kinds of models as payors and health plans become more creative in the development of their alternatives.

Excerpted from: Healthcare Trends & Forecasts in 2014: Performance Expectations for the Healthcare Industry

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Posted in Accountable Care Organizations, Bundled Payments, Case Management, Data Analytics, Healthcare Trends, Patient-Centered Medical Home, Physician Practices, Population Health Management, Telehealth & Telemedicine | Comments Off on 3 2014 Trends for Health Plans

Infographic: ACOs’ and PCMHs’ Tools for Success

June 21st, 2013 by Melanie Matthews

The primary motivator for becoming an ACO or PCMH is to improve patient outcomes (66%). That consideration is seconded by two separate motivators: being able to better utilize resources across the health care system (41%) and maintaining market share (40%), according to a new study by eClinicalWorks.

eClinicalWorks has released an infographic on the study results, highlighting the biggest challenges for ACOs, along with the most valuable tools in an ACO.

ACOs and PCMHs Tools for Success

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You may also be interested in this related resource: Guide to ACOs.

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