Patient-Centered Medical Home (PCMH)

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Patient-Centered Medical Home (PCMH):
A model of Delivering Primary Care
Presented by: Kimtuyen Tran
Smith College ‘13 Undergrad,
CHCACT Intern
June 13, 2012
Purpose of Presentation
 Mission of Community Health Center Association of
CT (CHCACT)
 Mission of Federally Qualified Health Centers (FQHCs)
 What is a Patient Centered Medical Home (PCMH)
and Why It Is Important
 CT’s PCMH Initiative
Mission of CHCACT
1
 CHCACT is a Primary Care Association that provides
training and technical assistance to FQHCs in CT
Mission: To enable CT FQHCs to provide access to
the highest quality health care and social services to
CT’s medically underserved populations.
Mission of FQHC
 FQHCs serve individuals in medically underserved
communities
 14 CT FQHCs
 13 CT FQHCs are members of CHCACT
 FQHCs provide primary care, behavioral health, and
dental care
Why do FQHCs exist?
 The way in which healthcare is financed allows
for poor areas to be underserved.
 Private practices essentially run like a business
 Medicaid does not pay for the costs of care
 The uninsured cannot afford to pay for the costs
 The Federal Government pays a cost-based
reimbursement
Crisis in Primary Care
2
 65 million Americans live in officially designated primary care
shortage areas
 Only 27% of adults in U.S. can easily contact their primary care
provider
 50% of patients do not understand what their primary care
providers told them because visits are too short to properly
address their health concerns
 Lack of coordination between PCPs, specialists, and hospitals
PCMH Model
 Patient Centered Medical
Homes (PCMH) are not
buildings, nursing homes,
or hospitals, but a
different way of
delivering care.3
Joint Principles of the PCMH
Adopted by AAFP, ACP, AAP, AOA 4:
 Personal Clinician (MD, NP, PA all of whom have their
own panel of patients and practice in primary care)
 Clinician Directed Medical Practice
 Whole Person Orientation
 Care is Coordinated and Integrated
 Quality and Safety are Hallmarks
 Enhanced Access
 Payment Reform
Health Care Reform: Opportunity to redesign
the way health care is delivered and funded

Workforce Supply and Training
 Obama Administration and HHS Announce New $250 Million Investment to Strengthen
Primary Health Care Workforce Through: (1) Creating additional primary care residency slots; (2)
Supporting physician assistant training in primary care; (3) Encouraging students to pursue full-time nursing
careers; (4) Establishing new nurse practitioner-led clinics; and (5) Encouraging states to plan for and address
health professional workforce needs

Medicaid and Medicare Pilots
 Section 2703 of the Patient Protection and Affordable Care Act creates a new Medicaid
state plan option to cover medical homes, beginning January 1, 2011, under which certain Medicaid
enrollees with chronic conditions could designate a health home, as defined by the Secretary. States that choose to offer
this benefit option, will be reimbursed for payments by the federal government 90% for the first eight fiscal quarters.
 Establishment of Center for Medicare and Medicaid Innovation within CMS. The purpose of
the Center will be to research, develop, test, and expand innovative payment and delivery arrangements to improve the
quality and reduce the cost of care provided to patients in each program.

Payment Reform
 Payments to primary care physicians. Requires that Medicaid payment rates to primary care physicians for
furnishing primary care services be no less than 100% of Medicare payment rates in 2013 and 2014.
 Expanding access to primary care services and general surgery services. Beginning in 2011,
provides primary care practitioners, as well as general surgeons practicing in health professional shortage areas, with a
10 percent Medicare payment bonus for five years
Where are the PCMHs?
Picture Courtesy of NCQA PCMH 2011 Overview 5
EVIDENCE OF COST SAVINGS &
QUALITY IMPROVEMENT 7
HealthPartners Medical Group
BestCare PCMH Model
 39% decrease in emergency
department visits
 24% decrease in hospital
admissions per enrollee
 Overall costs for enrollees
decreased by 8%
Johns Hopkins Guided Care
PCMH Model
 24% reduction in total hospital
inpatient days
 15% fewer ER visits
 37% decrease in skilled nursing
facility days
 Annual net Medicare savings of
$75,000 per PCMH care
coordinator nurse deployed in
practice
EVIDENCE OF COST SAVINGS &
QUALITY IMPROVEMENT 7
Erie County PCMH Model
 Decreased duplication of
services and tests
 Lowered hospitalization rates
 Estimated savings of $1 million
for every 1,000 enrollees
Community Care of North Carolina
 40% decrease in
hospitalizations for asthma
 16% lower ER visits
 Cumulative savings of $974.5
million over 6 years
(2003-2008)
Why should FQHCs become a PCMH?
 It builds on what FQHCs have been doing for years:
 Providing comprehensive primary care and supportive
services
 Being accountable for quality of care delivered
 Chronic Care Model and Access Redesign
 Reporting to stakeholders our performance measures
 Evidence suggests that a PCMH improves outcomes
and reduce costs
 New payment systems are aligning with PCMH
Connecticut’s PCMH Initiative
 CT’s goal is for 100% of Medicaid Patients to be
in a PCMH by 2014
 CT’s Initiative began for Medicaid patients in
January 2012
Where are the PCMHs?
179 Sites and 663 Clinicians Recognized as PCMH in CT
Picture Courtesy of NCQA Recognition Directory 8
PCMH Challenges





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Motivation and Prioritization Across the Organization
Initial Capital and Restructuring Costs
Coordinating Care within the Practice and Beyond
Staff Training
Electronic Medical Records
Scheduling (Extended/Alternative Hours of Service)
References
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Community Health Center Association of Connecticut. (https://www.chcact.org/Content/Who_We_Are.asp)
Health Affairs. "Patient-Centered Medical Homes.” September 14, 2010.
(http://www.healthaffairs.org/healthpolicybriefs/brief.php?brief_id=25)
CT Health Policy Project. “FAQs about patient-centered medical homes in CT.” March 10, 2011.
(http://www.cthealthpolicy.org/medicalhome/20110310_faqs_pcmh_ct.pdf)
Patient-Centered Primary Care Collaborative. “Joint Principles of the Patient Centered Medical Home” March 2007.
(http://www.pcpcc.net/content/joint-principles-patient-centered-medical-home)
National Committee for Quality Assurance. “PCMH 2011 Overview.” January 13, 2011
(http://www.ncqa.org/LinkClick.aspx?fileticket=ag3nmIPXs5s%3d&tabid=631&mid=2435&forcedownload=true)
CT Medicaid Managed Care Council. “Care Management PCMH Committee: Patient Centered Medical Home
Presentation.” May 17,2012
(http://www.cga.ct.gov/ph/medicaid/mmcc/pccm/minutes/2012/0517/PCMH%20Care%20Management%20Committee%2
0Presentation%20%205%2017%202012%20-Revised.pdf)
Patient-Centered Primary Care Collaborative. “Outcomes of Implementing Patient Centered Medical Home Interventions:
A review of the Evidence from Prospective Evaluation Studies in the Unites States.” November 16, 2010
(www.pcpcc.net/files/evidence_outcomes_in_pcmh.pdf)
National Committee for Quality Assurance. Recognition Directory.
(http://recognition.ncqa.org/PSearchResults.aspx?state=CT&rp=5)
Patient-Centered Primary Care Collaborative. “Introduction to PCMH Video,” 2010. (http://www.pcpcc.net/content/emmi)
 Patient Centered Medical Home Video 9
Q&A

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