The Greater Richmond Patient Centered Medical Home Collaborative members (PCMH Collaborative) are community based, safety net organizations that rely on community investment to sustain their work. To ensure that value is delivered in return for this investment, each organization is committed to a program of continuous improvement and performance measurement.
To document ongoing quality improvement, the Patient Centered Medical Home Collaborative members review their performance compared to other clinics in the PCMH Collaborative and compare their quality measure performance to external standards. Current quality measures include tobacco cessation, cervical cancer screening, blood pressure control, and diabetes control. This practice is commonly called “benchmarking.”
For the most part, the updated NCQA benchmarks are not significantly different than those in the 2013 report from NCQA. The only measure that differs significantly is the Cervical Cancer Screening Rate, on which Medicaid health plans nationally performed lower (a lower screening rate) than the previous year.
Click the link to see how PCMH Collaborative members are demonstrating an Impact on Quality.
In recent months nine different studies have shown that PCMH recognition resulted in reductions in emergency department visits and/or hospitalization (NCQA, 9/3/14). The latest of these studies appeared in the Health Services Research Journal article titled Total Cost of Care Lower among Medicare Fee-for-Service Beneficiaries Receiving Care from Patient-Centered Medical Homes. The study was conducted by RTI International.
The purpose of this study was to compare health care utilization and costs of care between practices with and without NCQA PCMH recognition. Using the Medicare Fee-for-Service program, the authors compared 308 PCMHs with NCQA recognition to a sample of almost 2,000 non-accredited PCMHs over three years.
The main finding from the study was, “Relative to the comparison group, total Medicare payments, acute care payments and emergency room visits declined after practices received NCQA accreditation. The decline was larger for practices with sicker than average patients, for primary care practices and for solo practices.” In addition, accredited practices saw a five percent greater reduction in the trend of total Medicare payments than their non-accredited counterparts.
The results of this study reinforce a growing body of evidence that PCMH recognition is most effective for patients with chronic conditions, and that it may have a correlation with lower health care costs and utilization.
Click here to read the abstract and access the complete article. (There may be a fee for the complete article.)
Article citation: Health Services Research, Van Hasselt et al, Total Cost of Care Lower among Medicare Fee-for-Service Beneficiaries Receiving Care from Patient-Centered Medical Homes, July 2014.
The American Journal of Managed Care article Structural Capabilities in Small and Medium-Sized Patient-Centered Medical Homes describes the first study to look at structural capabilities and change over time in small- to medium-sized primary care practices participating in Patient-Centered Medical Homes (PCMH) pilots. The authors examined the structural capabilities of 30 pilot projects and change over time in five Rhode Island pilot projects. Their findings show that small- and medium-size primary care practices are able to achieve a high level of medical home capability.
The study used the National Committee for Quality Assurance’s Physician Practice Connections—Patient-Centered Medical Home (PPC-PCMH) accreditation survey data to determine that:
- On average, practices earned a total score of 73 points (out of 100) for their structural capabilities at baseline.
- High- and low-performing practices differed most in their achievement on electronic prescribing, patient self-management, and care management standards.
- Rhode Island practices had an average score of 42 points at baseline and 90 points after 24 months.
- Building structural capabilities requires attention to payment reform, implementation and cultural change.
Approaches that facilitated PCMH achievement included payment incentives, “transformation coaches,” learning collaboratives, and data availability to support performance management and quality improvement. Conditions that hindered PCMH achievement included the extent of transformation required, technology shortcomings, slow cultural change, change fatigue, and lack of broader payment reform.
Small- and medium-sized practices, currently working on achieving PCMH accreditation should be encouraged by these findings. Providers will want to review the description of the approaches that facilitate and hinder PCMH achievement to determine if any changes are needed for their own practices.
Click here to read the entire AJMC article.
The use of patient-reported measures is the subject of a recent Institute for Healthcare Improvement (IHI) article titled How Do Patient-Reported Measures Contribute to Value in Health Care? The article is based on an interview by IHI Vice President Kathy Luther with IHI Communications Specialist Jo Ann Endo. Ms. Endo discusses the potential for patient-reported measures (PRMs) to catch direct input from patients to improve care delivery and assist organizations to develop value-based systems.
Highlights from the article include:
- PRMs provide the patient’s perspective on their health status. PRMs are different from other types of standardized data collection tools because they ask patients specific questions related to their condition and their life at the time of the interview.
- PRMs require baseline data through questions that obtain information on how the patient is functioning before treatment or interventions. Following treatment or interventions the patient is then questioned at regular intervals on the same PRMs.
- Collecting PRMs from patients with similar conditions, over time, allows providers to learn what works and what doesn’t in patient care. This information enables providers and patients to make informed treatment decisions.
- The challenge to using PRMs is that the data needs to be collected over time. This requires health care organizations to have a long term relationship patients and embed tools and procedures into normal procedures.
Use of PRMs is relatively new in the U.S. but it has been used extensively and successfully in Europe. PRMs don’t easily fit into the U.S. fee-for-service system but this type of data will be crucial as population health and value-based health care become the norm.
Click here to learn more and read the article at IHI.
The Virginia Atlas of Community Health has been updated with new data and enhanced for easier use. Check it out at www.atlasva.org.
In 2010 the Veterans Health Administration (VHA) began a nationwide initiative called Patient Aligned Care Teams (PACT) that reorganized care at all VHA primary care clinics in accordance with the patient-centered medical home model. The researchers in this article published in Health Affairs analyzed data for fiscal years 2003–12 to assess how trends in health care use and costs changed after the implementation of PACT. They found that PACT was associated with “modest increases in primary care visits and with modest decreases in both hospitalizations for ambulatory care–sensitive conditions and outpatient visits with mental health specialists.” The researchers found that the PACT model did not produce a positive return on investment in terms of the cost, but they noted that “trends in costs and use are favorable. Adopting patient-centered care does not appear to have been a major financial risk for the VHA.”
As stated by the authors of the article, “An organization’s decision to adopt the patient-centered medical home model should be based not upon unrealistic expectations of substantial cost savings but upon expected benefits, such as improved quality of care and high satisfaction with care. Over time, however, there may well be incremental savings.” This statement about ROI versus quality of care is a consistent thread throughout the latest PCMH impact research.
Click here to access the full article published in the June issue of Health Affairs.
The Patient Centered Primary Care Collaborative (PCPCC) published patient centered medical home (PCMH) activity through state programs across the United States. Each state page includes a checklist of potential programs states can use to expand PCMH activity (e.g., legislation, regulations, grant-funded demonstration programs, etc.), a listing of PCMH programs grouped by public, private and/or multi-payer type, evaluation data, population health data and statistics, and state-specific news.
Compared to other states, Virginia has a low level of PCMH activity through state programs. This does not mean that there are fewer PCMH recognized clinicians/practices in Virginia, but rather it speaks to state policy and programs related to the medical home. Click here to view Virginia’s page on the PCPCC website.
This study published in the American Journal of Managed Care in May 2014 examined healthcare expenditures among nonelderly adults with hypertension, as compared to patients with other chronic conditions and well patients. The study found “the prevalence of high total [healthcare expenditure] burdens was significantly greater for persons receiving treatment for hypertension (13.1%) compared with other chronically ill (10.5%) and well patients (5.3%).” These financial burdens to care result in individuals foregoing or delaying care. The study found that “35.2% among the uninsured and 23.9% among those with public coverage said they were unable to get care due to financial reasons.”
In this new health care environment, patients may be transitioning to healthcare coverage and out of the safety net setting. But it is important to understand the barriers to care for specific patient populations, which may include segments of the chronic disease population such as those with hypertension in particular. Addressing these barriers is crucial for the well-being of these patients.
Click here to read the full study.
The Commonwealth Fund’s Scorecard on State Health System Performance, 2014, assesses states on 42 indicators of health care access, quality, costs, and outcomes over the 2007–2012 period, which includes the Great Recession and precedes the major coverage expansions of the Affordable Care Act. Changes in health system performance were mixed overall, with states making progress on some indicators while losing ground on others.
“This state scorecard underscores the importance of national and state actions to ensure that no matter where a person lives, they have access to an affordable, high-quality health system,” said Commonwealth Fund Senior Vice President Cathy Schoen. Radley_aiming_higher_2014_state_scorecard
This report was prepared by Qualis Health to share insights and lessons learned about PCMH development in the safety net setting. From the report summary:
This white paper was prepared to disseminate the learnings from the REACH Healthcare Foundation Medical Home Initiative to the broader health community as primary care practice is redesigned to adopt the patient-centered medical home (PCMH) model of care. It examines the journey of nine safety net primary care clinics in Kansas City as they strive to integrate components of patient-centered care into their daily work.
The results are instructive for safety net clinics, collaboratives, and funders. Click here to read the report (in pdf format) from the Qualis Health website.