While the concept of a medical home was first introduced in 1967, it has gained popularity in recent years with providers, patients and healthcare plans due to mounting evidence showing how medical home programs improve health outcomes and reduce costs while strengthening the relationship between patients and primary care providers. The concept seeks to build processes that encourage physicians’ practices to spend time on patient counseling and education, report and monitor clinical outcomes, and assist in the coordination of care with other healthcare providers.
The Colorado Multipayer Patient-Centered Medical Home Pilot, which ran from May 2009 through April 2012, was one of the first voluntary multipayer medical home pilot projects in the country. Six health plans, the state’s high-risk pool carrier, and sixteen family or internal medicine practices with approximately 100,000 patients participated. Although a full analysis is currently under way, preliminary results show that the pilot significantly reduced emergency department visits and also reduced hospital admissions, particularly for patients with multiple chronic conditions.
2010 Results: By sharing data, the three organizations have been able to identify where costs are unduly high and implement solutions to bring those costs down.
Overutilization: Hysterectomies and elective knee surgeries were revealed to be the biggest cost drivers in the region among CalPERS members. Hill Physicians and Dignity are collaborating on alternatives, including evidence-based approaches to therapy and treatments that should be pursued before recommending surgery.
CareFirst BlueCross BlueShield (CareFirst) today announced that nearly 60 percent of eligible primary care Panels (small groupings/teams of primary care physicians and nurse practitioners) earned increased reimbursements for their 2011 performance in CareFirst's Patient-Centered Medical (PCMH) program. Increased reimbursements - or Outcome Incentive Awards (OIAs) - are based on a combination of savings achieved by a particular Panel against projected 2011 total care costs for CareFirst members as well as the attainment of quality points in the provision of care to Panel patients.
The PCMH is a model of healthcare based on an ongoing, personal relationship between a patient, a primary care physician and the patient’s care team that aims to assure comprehensive, coordinated care across all aspects of the healthcare system. For example, the PCMH-based care team personally manages, facilitates and coordinates care with appropriate qualified professionals -- such as hospitals, nursing homes, pharmacies and related community resources – as well as engages patients in promoting wellness and prevention and managing any chronic conditions they may have.
