To expand access for medically complex children, health systems need to rethink the medical home through continuous virtual and in-home care, rather than simply adding providers or clinics, said Dr. Patricia Hayes of Imagine Pediatrics.
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Recently, we got feedback from the residents in our [primary care outpatient teaching] program. We heard how frustrated they are by their lack of administrative time, lack of supportive staff, the volume of patients they’re expected to see in such a short amount of time, and the general chaos that exists at the practice.
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Comprehensive primary care promises to transform the U.S. health care system by unlocking powerful health improvements and cost savings for patients and taxpayers. By investing in primary care, lawmakers can improve the health and wellbeing of all Americans.
The package of fact sheets below examines the state of primary care in all 50 states and the District of Columbia.
This bill mandates that Medicaid and NJ FamilyCare managed care organizations provide primary care providers with either a patient-centered medical home model or an alternative payment model that incentivizes high-quality, cost-efficient, and holistic care.
This month, the Primary Care Collaborative is thrilled to honor Louise Probst, the soon-to-be-retired Executive Director of the St. Louis Area Business Health Coalition, as its Primary Care Champion.
Probst has spent more than two decades with the St. Louis Area Business Health Coalition and has supported multiple efforts to improve access to and quality of care for local workforces.
“I believe that everybody deserves a trusted and continuous relationship with a primary care clinician that truly knows and understands them,” said Probst, explaining her decades-long commitment to advancing primary care. “I really believe… that advancing primary care is… one of the foundational things that we need to do to really put our health system on a better path.”
Probst also stressed that effective primary care needs to take a holistic approach to health – and, ideally, should include a large focus on lifestyle.
Finally, Probst stressed the importance of placing primary care of the American health care system.
In a recent North Carolina Medical Journal article on the importance of physician assistants/associates, the PCC’s mission was higlighted.
“The nonprofit Primary Care Collaborative (PCC) promotes a transformation of the health care delivery system that is built on a strong foundation of primary care using a medical home model. The PCC model promotes an interdisciplinary team approach that includes PAs focused on patient engagement and trust. This model is patient-centered, coordinated, accessible, and committed to quality and safety. In order for patients and families to manage and organize their care and fully participate in shared decision-making, there must be a focus on strong and trusted relationships with the care team and open communication regarding health status.”
Check out the full article below.
PCC joined more than 800 health care associations, accountable care organizations (ACOs), medical practices, and health systems to urge Congressional leaders to extend incentive payments meant to encourage participation in risk-bearing alternative payment models (APMs), in a letter released on September 28, 2022. Those incentives expire at the end of the year unless Congress acts.
Congress in 2015 created a 5 percent incentive payment to support new payment models. While there are nearly 300,000 clinicians expected to receive the incentive this year, that number is far below Congressional expectations when the incentives were established. Therefore, the letter calls on lawmakers to extend the incentives to allow more time for a greater number of practices to move into APMs, which have shown an ability to improve quality and lower overall cost of care.
Failure to renew the incentives could deter participation in a range of primary care payment reform initiatives, including the Primary Care First, state primary care payment reform initiatives like the Maryland Primary Care Program, the Medicare Shared Savings Program, and private sector primary care initiatives. Ending these important incentive payments would discourage future participation in models that have seen growing uptake in recent years, the letter states. The incentive payments…provide additional resources that can be used to expand services beyond traditional fee-for-service.
Read the full letter here.
A new approach to patient-centered medical home care focused on addressing high-value elements (HVE) does not drop healthcare costs for patients treated at primary care practices, according to a new study.
Clinics utilizing the new model targeted aspects of care that were projected to improve outcomes while lowering costs, such as team-based care for managing chronic diseases. Compared to non-HVE clinics, however, the redesigned approach led to fewer hospitalizations but also more visits to emergency departments and no change in costs, experts reported in the February issue of Medical Care.
Objective: To examine associations between clinics’ extent of patient-centered medical home (PCMH) implementation and improvements in chronic illness care quality.
Data source: Data from 808 Veterans Health Administration (VHA) primary care clinics nationwide implementing the Patient Aligned Care Teams (PACT) PCMH initiative, begun in 2010.
Design: Clinic-level longitudinal observational study of clinics that received training and resources to implement PACT. Clinics varied in the extent they had PACT components in place by 2012.
Data collection: Clinical care quality measures reflecting intermediate outcomes and care processes related to coronary artery disease (CAD), diabetes, and hypertension care were collected by manual chart review at each VHA facility from 2009 to 2013.
Findings: In adjusted models containing 808 clinics, the 77 clinics with the most PACT components in place had significantly larger improvements in five of seven chronic disease intermediate outcome measures (e.g., BP < 160/100 in diabetes), ranging from 1.3 percent to 5.2 percent of the patient population meeting measures, and two of eight process measures (HbA1c measurement, LDL measurement in CAD) than the 69 clinics with the least PACT components. Clinics with moderate levels of PACT components showed few significantly larger improvements than the lowest PACT clinics.
Conclusions: Veterans Health Administration primary care clinics with the most PCMH components in place in 2012 had greater improvements in several chronic disease quality measures in 2009-2013 than the lowest PCMH clinics.
Background
Summary
Ann O’Malley Reaction
Discussion Summary
Objective: To examine the association between medical home enrollment and receipt of recommended care for Medicaid beneficiaries with multiple chronic conditions (MCC).
Data sources/study setting: Secondary claims data from fiscal years 2008-2010. The sample included nonelderly Medicaid beneficiaries with at least two of eight target conditions (asthma, chronic obstructive pulmonary disease, diabetes, hypertension, hyperlipidemia, seizure disorder, major depressive disorder, and schizophrenia).
Study design: We used linear probability models with person- and year-level fixed effects to examine the association between patient-centered medical home (PCMH) enrollment and nine disease-specific quality-of-care metrics, controlling for selection bias and time-invariant differences between enrollees.
Data collection methods: This study uses a dataset that links Medicaid claims with other administrative data sources.
Principal findings: Patient-centered medical home enrollment was associated with an increased likelihood of receiving eight recommended mental and physical health services, including A1C testing for persons with diabetes, lipid profiles for persons with diabetes and/or hyperlipidemia, and psychotherapy for persons with major depression and persons with schizophrenia. PCMH enrollment was associated with overuse of short-acting ?-agonists among beneficiaries with asthma.
Conclusions: The PCMH model can improve quality of care for patients with multiple chronic conditions.
In this segment of the recording of the recording, Dr. Karen Swietek, PhD, senior health economist at NORC presented the paper.
Summary Discussion Highlights: