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The Patient-Centered Medical Home Impact on Cost and Quality: An Annual Review of Evidence

The document reviews evaluations of the Patient-Centered Medical Home (PCMH) model from 2012-2013, highlighting significant improvements in clinical outcomes and cost-effectiveness across various studies. It emphasizes the role of PCMH in healthcare delivery reform and evolving payment structures, with widespread recognition and integration into Medicaid programs. Despite these advancements, gaps remain in clinician satisfaction reports and further research is needed to solidify the model's impact.

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CHCI Weitzman symposium May 2014 J. Nwando Olayiwola, MD, MPH, FAAFP Associate Director, Center for Excellence in Primary Care Assistant Professor, Department of Family & Community Medicine University of California, San Francisco The Patient-Centered Medical Home’s Impact on Cost and Quality: A Review of the Evidence from 2012-2013
Authors Marci Nielsen, PhD, MPH Chief Executive Officer, PCPCC J. Nwando Olayiwola, MD, MPH, FAAFP Associate Director, Center for Excellence in Primary Care; Assistant Professor, Department of Family and Community Medicine, University of California, San Francisco Paul Grundy, MD, MPH President, PCPCC; Global Director, Healthcare Transformation, IBM Kevin Grumbach, MD Professor and Chair, Department of Family and Community Medicine; University of California, San Francisco Lisa Dulsky Watkins, MD Former Associate Director, Vermont Blueprint for Health
Reviewers Melinda Abrams, MS Vice President, Health Care Delivery System Reform; The Commonwealth Fund Asaf Bitton, MD, MPH Instructor, Division of General Medicine, Brigham and Women's Hospital; Instructor, Department of Health Care Policy, Harvard Medical School Mark Gibson Director, Center for Evidence-Based Policy; Oregon Health & Science University Bruce Landon, MD, MBA, MSc Professor of Health Care Policy, Harvard Medical School; Professor of Medicine, Division of General Medicine and Primary Care; Beth Israel Deaconess Medical Center Len Nichols, PhD Director, Center for Health Policy Research and Ethics; George Mason University Kavita Patel, MD Managing Director for Clinical Transformation and Delivery; Engelberg Center for Health Care Reform; Fellow, Economic Studies The Brookings Institution Mary Takach, MPH, RN Senior Program Director; National Academy for State Health Policy
Take Home Points PCMH evaluations over the past year reported significant improvements across a broad range of clinical and financial outcomes The PCMH is playing an increasingly critical role in delivery system reform, including ACOs and the medical neighborhood Significant payment reforms continue to incorporate the PCMH
The Landscape: PCMH Momentum
NCQA Recognized PCMH By State – 12/31/10 Source: Analysis by the National Committee for Quality Assurance, Dec. 2010.
NCQA-Recognized Practices Across the United States ME VT RI NJ MD MA DE NY WA OR AZ NV WI NM NE MN KS FL CO IA NC MI PA OH VAMO HI OK GA SC TN MT KY WV AR LA AL INIL SD ND TX ID WY UT AK CA CT NH MS 61–200 sites 21–60 sites 0 sites 1–20 sites 201+ sites Source: Analysis by the National Committee for Quality Assurance, Oct. 2012. 4,937 sites & 23,396 clinicians as of 10/31/2012
PCMH Recognized Physicians and Sites: Growth Over Time
National Imperative: Triple Aim Source : Berwick, Donald M., Thomas W. Nolan, and John Whittington. "The triple aim: care, health, and cost." Health Affairs 27.3 (2008): 759-769.
Methods • Examined medical home/PCMH studies published between August 2012 and December 2013 – Peer-reviewed scholarly articles – Industry reports • Explored relationship between “medical home/PCMH” model of care and Triple Aim outcomes – Predictor variable: “Medical home” or “PCMH” – Outcome variables: Cost & utilization; care experience (access & patient satisfaction); health outcomes (population health & preventive services) • Resulted in 13 peer reviewed (academic) studies, and 7 industry reports
13 Peer-Reviewed (Academic) Studies • Alaska Southcentral Foundation • Colorado Multi-Payer PCMH Pilot • BlueCross BlueShield Michigan • Military Health System • Veterans Health Administration • New Hampshire Citizens Health Initiative • Horizon BlueCross BlueShield • EmblemHealth – New York • WellPoint - New York • UPMC Health Plan • Rhode Island Chronic Care Sustainability Initiative • University of Utah • Group Health Cooperative
• BlueCross BlueShield Alabama • Connecticut Health Enhancement Program • Horizon Blue Cross Blue Shield • BlueCross BlueShield Michigan • CareFirst BlueCross BlueShield • Oregon Coordinated Care Organizations • Highmark PCMH Pilot 7 Industry generated Reports
Key Point #1: PCMH evaluations report improvements across a broad range of clinical and financial outcomes
PCMH Peer ReviewedPeer Reviewed Outcomes
PCMH Industry GeneratedIndustry Generated Outcomes
Key Point #2: PCMHs play a critical role in delivery system reform, including ACOs and the medical neighborhood
Public Health Employers Schools Faith-Based Organizations Community Centers Home Health Hospital Pharmacy Diagnostics Specialty & Subspecialty Patient-Centered Medical Home Community Organizations Connected via Health IT $ $ PCMH: Foundation to ACOs & the Medical Neighborhood
Emerging Trends
ACO Climate and Opportunities
ACO Growth Over Time Source: Muhlestein D. Accountable Care Growth in 2014: A Look Ahead. Health Affairs Blog. January 2014
ACOs by Sponsoring Entity Source: Muhlestein D. Accountable Care Growth in 2014: A Look Ahead. Health Affairs Blog. January 2014
Estimated ACO Lives 2014 Source: Muhlestein D. Accountable Care Growth in 2014: A Look Ahead. Health Affairs Blog. January 2014
Key Point #3: Significant payment reforms continue to incorporate the PCMH
Payment Reform Drivers – Making the Case
Policy Influences Sustainable Growth Rate (SGR) • “Volume to Value” • Federal legislation = long term adoption • Encourages more providers to accept risk-based payments (5% Medicare increase) • Repeal calls for PCMH as supportive framework • Will lead to broader acceptance of PCMH and ACOs State Medicaid Activity and Expansions • “Volume to Value” • State based = short term adoption • Oregon and Utah pioneers in state Medicaid ACO • Providers bear some risk while meeting quality benchmarks • State based reimbursements for PCMH recognition important driver
Payment Reforms Source: S. Guterman, M. Zezza, C. Schoen, Paying for Value: Replacing Medicare's Sustainable Growth Rate Formula with Incentives to Improve Care, The Commonwealth Fund, March 2013.
Private Sector Reforms • Commercial health plans moving from traditional fee-for-service models • Transition from PCMH “demonstrations” to standard business operations – Incentives for primary care – PCMH incentives – Care coordination reimbursements – PMPM add ons
Overview of Medicaid Medical Home Activity 42 State Medicaid/CHIP Programs Planning/Implementing PCMH 27 Making Medical Home Payments Source: National Academy for State Health Policy State Scan, October 2012, http://www.nashp.org/med-home-map. WA OR TX CO NC LA PA NY IA VA NE OK RI AL MD MT ID KS MN MA ME AZ VT MOCA WY NM IL WI MI WV SC GA FL HI UT NV ND SD AR IN OH KY TN MS AK Significant activity for Medicaid/CHIP PCMH advancement (15 states) No PCMH Medicaid activity (8 states) States making payments for PCMH (27 states) NJ DE NH CT
Overview of Medicaid Medical Home Activity 47 State Medicaid/CHIP Programs Planning/Implementing PCMH 30 Making Medical Home Payments, 22 Involved in Multi-payer Pilots WA OR TX CO NC LA PA NY IA VA NE OK RI AL MD MT ID KS MN NH MA ME AZ VT MOCA WY NM IL WI MI WV SC GA FL HI UT NV ND SD AR IN OH KY TN MS AK Significant activity for Medicaid/CHIP PCMH advancement (26 states + DC) Medicaid multi-payer activity/involvement (22 states) States making payments for PCMH (30 states) NJ DE Source: National Academy for State Health Policy State Scan, May 2014, http://www.nashp.org/med-home-map. CT DC
WA OR TX CO NC LA PA NY IA VA NE OK AL MD MT ID KS MN ME AZ VT MOCA WY NM IL WI MI WV SC GA FL HI UT NV ND SD AR IN OH KY TN MS AK National Momentum: Spread of Medical Homes At Least One Payer in 49 States Testing PCMH Multi-payer payment (22 states) Identified pilot activity (49 states) No identified pilot activity (1 state) Source: Patient Centered Primary Care Collaborative and National Academy for State Health Policy, updated May 2014 DE NH RI MA CT NJ
The Year in Review: Case Study Snapshots
Veterans Health Administration Patient Aligned Care Team • Optimize workflow and coordinate care through the use of an interprofessional “teamlet” model • Enact advanced scheduling, such as same-day appointments • Add phone consults and group appointments 1. PCMH studies continue to demonstrate impressive improvements range of categories including: cost, utilization, population health access to care, and patient satisfaction, while a gap still exists in on clinician satisfaction. • Decreases in the cost of care, PEER-REVIEW/ACADEMIA 61% 61% 31% 13% 31% 31% 57% 57% 57% 29% 29% 14% Cost Reductions Fewer EDVisits Fewer Inpatient Admissions Fewer Readmissions Improvement in PopulationHealth Improved Access INDUSTRY REPORTS (n= 13) (n= 8) (n= 4) (n= 1) (n= 4) (n= 4) (n= 4) (n= 4) (n= 4) (n= 2) (n= 2) (n= 1) Total Studies (n= 7) (n= 8) Reported outcomes Reported outcomes udies continue to demonstrate impressive improvements across a broad categories including: cost, utilization, population health, prevention, o care, and patient satisfaction, while a gap still exists in reporting impact an satisfaction. EMIA 61% 61% 31% 13% 31% 31% 31% Cost Reductions Fewer EDVisits Fewer Inpatient Admissions Fewer Readmissions Improvement in PopulationHealth Improved Access Improvement in Satisfaction IncreaseinPreventive Services S = 13) (n= 8) (n= 4) (n= 1) (n= 4) (n= 4) (n= 4) 23% (n= 3) otal udies (n= 8) 1. PCMH studies continue to demonstrate impressive improvements across a range of categories including: cost, utilization, population health, prevent access to care, and patient satisfaction, while a gap still exists in reportin on clinician satisfaction. PEER-REVIEW/ACADEMIA 61% 61% 31% 13% 31% 31% 31% 57% 57% 57% 29% 29% 14% 29% Cost Reductions FewerEDVisits Fewer Inpatient Admissions Fewer Readmissions Improvement in PopulationHealth Improved Access IncreaseinPrevent Services INDUSTRY REPORTS (n= 13) (n= 8) (n= 4) (n= 1) (n= 4) (n= 4) (n= 4) (n= 4) (n= 4) (n= 4) (n= 2) (n= 2) (n= 1) (n= 2) Total Studies (n= 7) (n= 8) Reported outcomes Reported outcomes National program 5 million patients ResultsPCMH Strategies • 8% fewer urgent care visits • 4% fewer inpatient admissions • Decrease in face-to-face visits • Increase in phone encounters, personal health record use, and electronic messaging to providers Source: Rosland, A.M., Nelson, K., Sun, H., Dolan, E.D., Maynard, C., Bryson, C., Stark, R., Schectman, D., (2013). The Patient-Centered Medical Home in the Veterans Health Administration. American Journal of Managed Care. 1-4.
BlueCross BlueShield of Michigan Physician Group Incentive Program Michigan 3 million patients ResultsPCMH Strategies • 13.5% fewer pediatric ED visits • 10% fewer adult ED visits • 17% fewer inpatient admissions • 6% fewer hospital readmissions 1. PCMH studies continue to demonstrate impressive improvement range of categories including: cost, utilization, population healt access to care, and patient satisfaction, while a gap still exists i on clinician satisfaction. • Decreases in the cost of care, PEER-REVIEW/ACADEMIA 61% 61% 31% 13% 31% 31% 57% 57% 57% 29% 29% 14% Cost Reductions Fewer EDVisits Fewer Inpatient Admissions Fewer Readmissions Improvement in PopulationHealth Improved Access INDUSTRY REPORTS (n= 13) (n= 8) (n= 4) (n= 1) (n= 4) (n= 4) (n= 4) (n= 4) (n= 4) (n= 2) (n= 2) (n= 1) Total Studies (n= 7) (n= 8) Reported outcomes Reported outcomes 1. PCMH studies continue to demonstrate impressive improvements across range of categories including: cost, utilization, population health, preven access to care, and patient satisfaction, while a gap still exists in reporti on clinician satisfaction. PEER-REVIEW/ACADEMIA 61% 61% 31% 13% 31% 31% 31% 57% 57% 57% 29% 29% 14% 29% Cost Reductions Fewer EDVisits Fewer Inpatient Admissions Fewer Readmissions Improvement in PopulationHealth Improved Access IncreaseinPrev Services INDUSTRY REPORTS (n= 13) (n= 8) (n= 4) (n= 1) (n= 4) (n= 4) (n= 4) (n= 4) (n= 4) (n= 4) (n= 2) (n= 2) (n= 1) (n= 2) Total Studies (n= 7) (n= 8) Reported outcomes Reported outcomes 1. PCMH studies continue to demonstrate impressive improvements across a broad range of categories including: cost, utilization, population health, prevention, access to care, and patient satisfaction, while a gap still exists in reporting impac on clinician satisfaction. PEER-REVIEW/ACADEMIA 61% 61% 31% 13% 31% 31% 31% Cost Reductions FewerEDVisits FewerInpatient Admissions Fewer Readmissions Improvementin PopulationHealth Improved Access Improvement Satisfaction IncreaseinPreventive Services INDUSTRY REPORTS (n= 13) (n= 8) (n= 4) (n= 1) (n= 4) (n= 4) (n= 4) 23% (n= 3) Total Studies (n= 8) Reported outcomes 1. PCMH studies continue to demonstrate impressive imp range of categories including: cost, utilization, popula access to care, and patient satisfaction, while a gap s on clinician satisfaction. Cost Reductions Fewer EDVisits Fewer Inpatient Admissions Fewer Readmissions Improvem Population Total Studies • Savings of $26.37 PMPM • $155 million in cost savings Source: Blue Cross Blue Shield of Michigan. Patient-Centered Medical Home Fact Sheet. July 2013. Retrieved from http://www.valuepartnerships.com/wp- content/uploads/2013/07/2013-PCMH-Fact-Sheet.pdf. • Develop patient registries to track and monitor patients’ care • Offer 24-hour patient access to a clinical decision-maker through • extended office hours • telephone access • a linkage to urgent care • Provide online patient resources that allow for electronic communication and greater patient access to medical information
UPMC Health Plan Medical Home Pilot Pennsylvania 23,390 patients ResultsPCMH Strategies • 2.6% reduction in total costs • 160% ROI • 2.8% fewer inpatient admission • 6.6% increase in patients with controlled HbA1c 1. PCMH studies continue to demonstrate impressive improvements across a broad range of categories including: cost, utilization, population health, prevention, access to care, and patient satisfaction, while a gap still exists in reporting impa on clinician satisfaction. • Decreases in the cost of care, • Reductions in the use of unnecessary or avoidable services, PEER-REVIEW/ACADEMIA 61% 61% 31% 13% 31% 31% 31% 57% 57% 57% 29% 29% 14% 29% Cost Reductions Fewer EDVisits Fewer Inpatient Admissions Fewer Readmissions Improvement in PopulationHealth Improved Access Improveme Satisfact IncreaseinPreventive Services INDUSTRY REPO RTS (n= 13) (n= 8) (n= 4) (n= 1) (n= 4) (n= 4) (n= 4) (n= 4) (n= 4) (n= 4) (n= 2) (n= 2) (n= 1) (n= 2) 23% 14% (n= 3 (n= 1 Total Studies (n= 7) (n= 8) Reported outcomes Reported outcomes PAGE 6 1. PCMH studies continue to demonstrate impressive improveme range of categories including: cost, utilization, population he access to care, and patient satisfaction, while a gap still exist on clinician satisfaction. • Decreases in the cost of care, • Reductions in the use of unnecessary or avoidable services, PEER-REVIEW/ACADEMIA 61% 61% 31% 13% 31% 31 57% 57% 57% 29% 29% 14 Cost Reductions Fewer EDVisits Fewer Inpatient Admissions Fewer Readmissions Improvement in PopulationHealth Imp Ac INDUSTRY REPO RTS (n= 13) (n= 8) (n= 4) (n= 1) (n= 4) (n (n= 4) (n= 4) (n= 4) (n= 2) (n= 2) (n Total Studies (n= 7) (n= 8) Reported outcomes Reported outcomes 1. PCMH studies continue to demonstrate impressive improvements across a broad range of categories including: cost, utilization, population health, prevention, access to care, and patient satisfaction, while a gap still exists in reporting impact on clinician satisfaction. PEER-REVIEW/ACADEMIA 61% 61% 31% 13% 31% 31% 31% 57% 57% 57% 29% 29% 14% 29% Cost Reductions Fewer EDVisits Fewer Inpatient Admissions Fewer Readmissions Improvement in PopulationHealth Improved Access Improvement in Satisfaction IncreaseinPreventive Services INDUSTRY REPORTS (n= 13) (n= 8) (n= 4) (n= 1) (n= 4) (n= 4) (n= 4) (n= 4) (n= 4) (n= 4) (n= 2) (n= 2) (n= 1) (n= 2) 23% 14% (n= 3) (n= 1) Total Studies (n= 7) (n= 8) Reported outcomes Reported outcomes CMH studies continue to demonstrate impressive improvements across a broad ange of categories including: cost, utilization, population health, prevention, ccess to care, and patient satisfaction, while a gap still exists in reporting impact n clinician satisfaction. EVIEW/ACADEMIA 61% 61% 31% 13% 31% 31% 31% Cost Reductions Fewer EDVisits Fewer Inpatient Admissions Fewer Readmissions Improvement in PopulationHealth Improved Access Improvement in Satisfaction IncreaseinPreventive Services TRY REPORTS (n= 13) (n= 8) (n= 4) (n= 1) (n= 4) (n= 4) (n= 4) 23% (n= 3) Total Studies (n= 8) ted mes 1. PCMH studies continue to demonstrate impressive improvements across a broad range of categories including: cost, utilization, population health, prevention, access to care, and patient satisfaction, while a gap still exists in reporting impact on clinician satisfaction. PEER-REVIEW/ACADEMIA 61% 61% 31% 13% 31% 31% 31% 57% 57% 57% 29% 29% 14% 29% Cost Reductions Fewer EDVisits FewerInpatient Admissions Fewer Readmissions Improvement in PopulationHealth Improved Access Improvement in Satisfaction IncreaseinPreventive Services INDUSTRY REPORTS (n= 13) (n= 8) (n= 4) (n= 1) (n= 4) (n= 4) (n= 4) (n= 4) (n= 4) (n= 4) (n= 2) (n= 2) (n= 1) (n= 2) 23% 14% (n= 3) (n= 1) Total Studies (n= 7) (n= 8) Reported outcomes Reported outcomes • 18.3% fewer hospital readmissions • 23.2% increase in eye exams • 9.7% increase in LDL screenings • Practice-based nurses provide care management • Create telehealth options for care managers to connect to patients when in-office visits are not possible or necessary • Offer incentives to payers to enter into PCMH contracts Source: Rosenberg, C.N., Peele, P., Keyser, D., McAnallen, S., & Holder, D. (2012) Results from a patient-centered medical home pilot at UPMC Health Plan hold lessons for broader adoption of the model. Health Affairs. 31(11).
CareFirst BlueCross BlueShield Maryland Maryland 1 million patients ResultsPCMH Strategies • $98 million in total cost savings • 4.7% lower costs for physicians that received an incentive award 1. PCMH studies continue to demonstrate impres range of categories including: cost, utilization access to care, and patient satisfaction, while on clinician satisfaction. PEER-REVIEW/ACADEMIA 61% 61% 31% 13% 57% 57% 57% 29% Cost Reductions Fewer EDVisits Fewer Inpatient Admissions Fewer Readmissi INDUSTRY REPO RTS (n= 13) (n= 8) (n= 4) (n= 1 (n= 4) (n= 4) (n= 4) (n= 2 Total Studies (n= 7) (n= 8) Reported outcomes Reported outcomes ontinue to demonstrate impressive improvements across a broad ories including: cost, utilization, population health, prevention, and patient satisfaction, while a gap still exists in reporting impa isfaction. 61% 61% 31% 13% 31% 31% 31% Cost Reductions Fewer EDVisits Fewer Inpatient Admissions Fewer Readmissions Improvement in PopulationHealth Improved Access Improveme Satisfact IncreaseinPreventive Services (n= 8) (n= 4) (n= 1) (n= 4) (n= 4) (n= 4) 23% (n= 3(n= 8) • 3.7% higher quality scores for panels that received incentives • Quality scores for PCMH panels rose by 9.3% from 2011 to 2012 Source: CareFirst Blue Cross Blue Shield. Patient-centered medical home program trims expected health care costs by $98 million in second year. Press Release, June 2013. Retrieved from https://member.carefirst.com/wps/portal/!ut/p/c4/04_SB8K8xLLM9MSSzPy8xBz9CP0os3hLbzN_Q09LYwN • Use local care coordination teams to track high-risk members • Create an infrastructure for nursing support, easily- accessible online tools and data, and targeted health programs • Offer increased reimbursements to physicians based on performance in the program
Oregon Health Authority Coordinated Care Organizations (CCOs) Statewide Medicaid program 600,000 patients ResultsPCMH Strategies • 9% reduction in ED visits • 14-29% fewer ED visits for chronic disease patients • 12% fewer hospital readmissions • 18% reduction in ED visit spending • Reduced per capital health spending growth by >1% 1. PCMH studies continue to demonstrate impressive improvements range of categories including: cost, utilization, population health access to care, and patient satisfaction, while a gap still exists in on clinician satisfaction. • Decreases in the cost of care, PEER-REVIEW/ACADEMIA 61% 61% 31% 13% 31% 31% 57% 57% 57% 29% 29% 14% Cost Reductions Fewer EDVisits Fewer Inpatient Admissions Fewer Readmissions Improvement in PopulationHealth Improved Access INDUSTRY REPORTS (n= 13) (n= 8) (n= 4) (n= 1) (n= 4) (n= 4) (n= 4) (n= 4) (n= 4) (n= 2) (n= 2) (n= 1) Total Studies (n= 7) (n= 8) Reported outcomes Reported outcomes 1. PCMH studies continue to demonstrate impressive improvements across a broad range of categories including: cost, utilization, population health, prevention, access to care, and patient satisfaction, while a gap still exists in reporting impact on clinician satisfaction. PEER-REVIEW/ACADEMIA 61% 61% 31% 13% 31% 31% 31% 57% 57% 57% 29% 29% 14% 29% Cost Reductions Fewer EDVisits Fewer Inpatient Admissions Fewer Readmissions Improvement in PopulationHealth Improved Access Improvement in Satisfaction IncreaseinPreventive Services INDUSTRY REPORTS (n= 13) (n= 8) (n= 4) (n= 1) (n= 4) (n= 4) (n= 4) (n= 4) (n= 4) (n= 4) (n= 2) (n= 2) (n= 1) (n= 2) 23% 14% (n= 3) (n= 1) Total Studies (n= 7) (n= 8) Reported outcomes Reported outcomes 1. PCMH studies continue to demonstrate impressive impr range of categories including: cost, utilization, populat access to care, and patient satisfaction, while a gap st on clinician satisfaction. PEER-REVIEW/ACADEMIA 61% 61% 31% 13% 31% Cost Reductions Fewer EDVisits Fewer Inpatient Admissions Fewer Readmissions Improvemen PopulationHe (n= 13) Total Studies Reported outcomes Source: Oregon Health Authority. (2013). Oregon’s Health System Transformation: Quarterly Progress Report. Retrieved from http://www.oregon.gov/oha/Metrics/Documents/report-november-2013.pdf. • Establish a primary care infrastructure that includes 450 PCMH practices and clinics • Increase the use of outpatient care to promote prevention • Increase well-care visits to adolescents to reduce unnecessary ED visits • Provide follow-up care to patients within 7 days of being discharged
The Challenge of Studying the PCMH: The Right Metrics? • Right metrics? – Gap in clinician satisfaction measures – tied to workforce needs – Need for better/more patient satisfaction measures of self-reported health status/well-being – Measures need to account for patient diversity, socioeconomics and social determinants of health – Need for standard core measures – including behavioral health and oral health integration – Stronger case for connection to health equity
• Right methods? – Study designs appropriate for investigating complexity of health system reforms – Recognition that the model/philosophy is evolving – Evaluation often in the midst of multimodal change processes Source: Grumbach, Kevin. "The Patient-Centered Medical Home Is Not a Pill: Implications for Evaluating Primary Care Reforms." JAMA internal medicine 173.20 (2013): 1913-1914. The Challenge of Studying the PCMH: The Right Methods?
Take Home Points PCMH evaluations over the past year reported significant improvements across a broad range of clinical and financial outcomes The PCMH is playing an increasingly critical role in delivery system reform, including ACOs and the medical neighborhood Significant payment reforms continue to incorporate the PCMH
Thank You! Contact: J. Nwando Olayiwola, MD, MPH, FAAFP Associate Director, Center for Excellence in Primary Care University of California, San Francisco OlayiwolaJ@fcm.ucsf.edu Twitter: @DrNwando (415) 206-2970 (O)

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The Patient-Centered Medical Home Impact on Cost and Quality: An Annual Review of Evidence

  • 1.
    CHCI Weitzman symposiumMay 2014 J. Nwando Olayiwola, MD, MPH, FAAFP Associate Director, Center for Excellence in Primary Care Assistant Professor, Department of Family & Community Medicine University of California, San Francisco The Patient-Centered Medical Home’s Impact on Cost and Quality: A Review of the Evidence from 2012-2013
  • 3.
    Authors Marci Nielsen, PhD,MPH Chief Executive Officer, PCPCC J. Nwando Olayiwola, MD, MPH, FAAFP Associate Director, Center for Excellence in Primary Care; Assistant Professor, Department of Family and Community Medicine, University of California, San Francisco Paul Grundy, MD, MPH President, PCPCC; Global Director, Healthcare Transformation, IBM Kevin Grumbach, MD Professor and Chair, Department of Family and Community Medicine; University of California, San Francisco Lisa Dulsky Watkins, MD Former Associate Director, Vermont Blueprint for Health
  • 4.
    Reviewers Melinda Abrams, MS VicePresident, Health Care Delivery System Reform; The Commonwealth Fund Asaf Bitton, MD, MPH Instructor, Division of General Medicine, Brigham and Women's Hospital; Instructor, Department of Health Care Policy, Harvard Medical School Mark Gibson Director, Center for Evidence-Based Policy; Oregon Health & Science University Bruce Landon, MD, MBA, MSc Professor of Health Care Policy, Harvard Medical School; Professor of Medicine, Division of General Medicine and Primary Care; Beth Israel Deaconess Medical Center Len Nichols, PhD Director, Center for Health Policy Research and Ethics; George Mason University Kavita Patel, MD Managing Director for Clinical Transformation and Delivery; Engelberg Center for Health Care Reform; Fellow, Economic Studies The Brookings Institution Mary Takach, MPH, RN Senior Program Director; National Academy for State Health Policy
  • 5.
    Take Home Points PCMHevaluations over the past year reported significant improvements across a broad range of clinical and financial outcomes The PCMH is playing an increasingly critical role in delivery system reform, including ACOs and the medical neighborhood Significant payment reforms continue to incorporate the PCMH
  • 6.
  • 7.
    NCQA Recognized PCMHBy State – 12/31/10 Source: Analysis by the National Committee for Quality Assurance, Dec. 2010.
  • 8.
    NCQA-Recognized Practices Acrossthe United States ME VT RI NJ MD MA DE NY WA OR AZ NV WI NM NE MN KS FL CO IA NC MI PA OH VAMO HI OK GA SC TN MT KY WV AR LA AL INIL SD ND TX ID WY UT AK CA CT NH MS 61–200 sites 21–60 sites 0 sites 1–20 sites 201+ sites Source: Analysis by the National Committee for Quality Assurance, Oct. 2012. 4,937 sites & 23,396 clinicians as of 10/31/2012
  • 9.
    PCMH Recognized Physiciansand Sites: Growth Over Time
  • 10.
    National Imperative: TripleAim Source : Berwick, Donald M., Thomas W. Nolan, and John Whittington. "The triple aim: care, health, and cost." Health Affairs 27.3 (2008): 759-769.
  • 11.
    Methods • Examined medicalhome/PCMH studies published between August 2012 and December 2013 – Peer-reviewed scholarly articles – Industry reports • Explored relationship between “medical home/PCMH” model of care and Triple Aim outcomes – Predictor variable: “Medical home” or “PCMH” – Outcome variables: Cost & utilization; care experience (access & patient satisfaction); health outcomes (population health & preventive services) • Resulted in 13 peer reviewed (academic) studies, and 7 industry reports
  • 12.
    13 Peer-Reviewed (Academic)Studies • Alaska Southcentral Foundation • Colorado Multi-Payer PCMH Pilot • BlueCross BlueShield Michigan • Military Health System • Veterans Health Administration • New Hampshire Citizens Health Initiative • Horizon BlueCross BlueShield • EmblemHealth – New York • WellPoint - New York • UPMC Health Plan • Rhode Island Chronic Care Sustainability Initiative • University of Utah • Group Health Cooperative
  • 13.
    • BlueCross BlueShieldAlabama • Connecticut Health Enhancement Program • Horizon Blue Cross Blue Shield • BlueCross BlueShield Michigan • CareFirst BlueCross BlueShield • Oregon Coordinated Care Organizations • Highmark PCMH Pilot 7 Industry generated Reports
  • 14.
    Key Point #1: PCMHevaluations report improvements across a broad range of clinical and financial outcomes
  • 15.
    PCMH Peer ReviewedPeerReviewed Outcomes
  • 16.
  • 17.
    Key Point #2: PCMHsplay a critical role in delivery system reform, including ACOs and the medical neighborhood
  • 18.
    Public Health Employers Schools Faith-Based Organizations Community Centers Home Health Hospital PharmacyDiagnostics Specialty & Subspecialty Patient-Centered Medical Home Community Organizations Connected via Health IT $ $ PCMH: Foundation to ACOs & the Medical Neighborhood
  • 19.
  • 20.
    ACO Climate andOpportunities
  • 21.
    ACO Growth OverTime Source: Muhlestein D. Accountable Care Growth in 2014: A Look Ahead. Health Affairs Blog. January 2014
  • 22.
    ACOs by SponsoringEntity Source: Muhlestein D. Accountable Care Growth in 2014: A Look Ahead. Health Affairs Blog. January 2014
  • 23.
    Estimated ACO Lives2014 Source: Muhlestein D. Accountable Care Growth in 2014: A Look Ahead. Health Affairs Blog. January 2014
  • 24.
    Key Point #3: Significantpayment reforms continue to incorporate the PCMH
  • 25.
    Payment Reform Drivers– Making the Case
  • 26.
    Policy Influences Sustainable GrowthRate (SGR) • “Volume to Value” • Federal legislation = long term adoption • Encourages more providers to accept risk-based payments (5% Medicare increase) • Repeal calls for PCMH as supportive framework • Will lead to broader acceptance of PCMH and ACOs State Medicaid Activity and Expansions • “Volume to Value” • State based = short term adoption • Oregon and Utah pioneers in state Medicaid ACO • Providers bear some risk while meeting quality benchmarks • State based reimbursements for PCMH recognition important driver
  • 27.
    Payment Reforms Source: S.Guterman, M. Zezza, C. Schoen, Paying for Value: Replacing Medicare's Sustainable Growth Rate Formula with Incentives to Improve Care, The Commonwealth Fund, March 2013.
  • 28.
    Private Sector Reforms •Commercial health plans moving from traditional fee-for-service models • Transition from PCMH “demonstrations” to standard business operations – Incentives for primary care – PCMH incentives – Care coordination reimbursements – PMPM add ons
  • 29.
    Overview of MedicaidMedical Home Activity 42 State Medicaid/CHIP Programs Planning/Implementing PCMH 27 Making Medical Home Payments Source: National Academy for State Health Policy State Scan, October 2012, http://www.nashp.org/med-home-map. WA OR TX CO NC LA PA NY IA VA NE OK RI AL MD MT ID KS MN MA ME AZ VT MOCA WY NM IL WI MI WV SC GA FL HI UT NV ND SD AR IN OH KY TN MS AK Significant activity for Medicaid/CHIP PCMH advancement (15 states) No PCMH Medicaid activity (8 states) States making payments for PCMH (27 states) NJ DE NH CT
  • 30.
    Overview of MedicaidMedical Home Activity 47 State Medicaid/CHIP Programs Planning/Implementing PCMH 30 Making Medical Home Payments, 22 Involved in Multi-payer Pilots WA OR TX CO NC LA PA NY IA VA NE OK RI AL MD MT ID KS MN NH MA ME AZ VT MOCA WY NM IL WI MI WV SC GA FL HI UT NV ND SD AR IN OH KY TN MS AK Significant activity for Medicaid/CHIP PCMH advancement (26 states + DC) Medicaid multi-payer activity/involvement (22 states) States making payments for PCMH (30 states) NJ DE Source: National Academy for State Health Policy State Scan, May 2014, http://www.nashp.org/med-home-map. CT DC
  • 31.
    WA OR TX CO NC LA PA NY IA VA NE OK AL MD MT ID KS MN ME AZ VT MOCA WY NM IL WI MI WV SC GA FL HI UT NV ND SD AR IN OH KY TN MS AK National Momentum: Spreadof Medical Homes At Least One Payer in 49 States Testing PCMH Multi-payer payment (22 states) Identified pilot activity (49 states) No identified pilot activity (1 state) Source: Patient Centered Primary Care Collaborative and National Academy for State Health Policy, updated May 2014 DE NH RI MA CT NJ
  • 32.
    The Year inReview: Case Study Snapshots
  • 33.
    Veterans Health Administration Patient AlignedCare Team • Optimize workflow and coordinate care through the use of an interprofessional “teamlet” model • Enact advanced scheduling, such as same-day appointments • Add phone consults and group appointments 1. PCMH studies continue to demonstrate impressive improvements range of categories including: cost, utilization, population health access to care, and patient satisfaction, while a gap still exists in on clinician satisfaction. • Decreases in the cost of care, PEER-REVIEW/ACADEMIA 61% 61% 31% 13% 31% 31% 57% 57% 57% 29% 29% 14% Cost Reductions Fewer EDVisits Fewer Inpatient Admissions Fewer Readmissions Improvement in PopulationHealth Improved Access INDUSTRY REPORTS (n= 13) (n= 8) (n= 4) (n= 1) (n= 4) (n= 4) (n= 4) (n= 4) (n= 4) (n= 2) (n= 2) (n= 1) Total Studies (n= 7) (n= 8) Reported outcomes Reported outcomes udies continue to demonstrate impressive improvements across a broad categories including: cost, utilization, population health, prevention, o care, and patient satisfaction, while a gap still exists in reporting impact an satisfaction. EMIA 61% 61% 31% 13% 31% 31% 31% Cost Reductions Fewer EDVisits Fewer Inpatient Admissions Fewer Readmissions Improvement in PopulationHealth Improved Access Improvement in Satisfaction IncreaseinPreventive Services S = 13) (n= 8) (n= 4) (n= 1) (n= 4) (n= 4) (n= 4) 23% (n= 3) otal udies (n= 8) 1. PCMH studies continue to demonstrate impressive improvements across a range of categories including: cost, utilization, population health, prevent access to care, and patient satisfaction, while a gap still exists in reportin on clinician satisfaction. PEER-REVIEW/ACADEMIA 61% 61% 31% 13% 31% 31% 31% 57% 57% 57% 29% 29% 14% 29% Cost Reductions FewerEDVisits Fewer Inpatient Admissions Fewer Readmissions Improvement in PopulationHealth Improved Access IncreaseinPrevent Services INDUSTRY REPORTS (n= 13) (n= 8) (n= 4) (n= 1) (n= 4) (n= 4) (n= 4) (n= 4) (n= 4) (n= 4) (n= 2) (n= 2) (n= 1) (n= 2) Total Studies (n= 7) (n= 8) Reported outcomes Reported outcomes National program 5 million patients ResultsPCMH Strategies • 8% fewer urgent care visits • 4% fewer inpatient admissions • Decrease in face-to-face visits • Increase in phone encounters, personal health record use, and electronic messaging to providers Source: Rosland, A.M., Nelson, K., Sun, H., Dolan, E.D., Maynard, C., Bryson, C., Stark, R., Schectman, D., (2013). The Patient-Centered Medical Home in the Veterans Health Administration. American Journal of Managed Care. 1-4.
  • 34.
    BlueCross BlueShield of MichiganPhysician Group Incentive Program Michigan 3 million patients ResultsPCMH Strategies • 13.5% fewer pediatric ED visits • 10% fewer adult ED visits • 17% fewer inpatient admissions • 6% fewer hospital readmissions 1. PCMH studies continue to demonstrate impressive improvement range of categories including: cost, utilization, population healt access to care, and patient satisfaction, while a gap still exists i on clinician satisfaction. • Decreases in the cost of care, PEER-REVIEW/ACADEMIA 61% 61% 31% 13% 31% 31% 57% 57% 57% 29% 29% 14% Cost Reductions Fewer EDVisits Fewer Inpatient Admissions Fewer Readmissions Improvement in PopulationHealth Improved Access INDUSTRY REPORTS (n= 13) (n= 8) (n= 4) (n= 1) (n= 4) (n= 4) (n= 4) (n= 4) (n= 4) (n= 2) (n= 2) (n= 1) Total Studies (n= 7) (n= 8) Reported outcomes Reported outcomes 1. PCMH studies continue to demonstrate impressive improvements across range of categories including: cost, utilization, population health, preven access to care, and patient satisfaction, while a gap still exists in reporti on clinician satisfaction. PEER-REVIEW/ACADEMIA 61% 61% 31% 13% 31% 31% 31% 57% 57% 57% 29% 29% 14% 29% Cost Reductions Fewer EDVisits Fewer Inpatient Admissions Fewer Readmissions Improvement in PopulationHealth Improved Access IncreaseinPrev Services INDUSTRY REPORTS (n= 13) (n= 8) (n= 4) (n= 1) (n= 4) (n= 4) (n= 4) (n= 4) (n= 4) (n= 4) (n= 2) (n= 2) (n= 1) (n= 2) Total Studies (n= 7) (n= 8) Reported outcomes Reported outcomes 1. PCMH studies continue to demonstrate impressive improvements across a broad range of categories including: cost, utilization, population health, prevention, access to care, and patient satisfaction, while a gap still exists in reporting impac on clinician satisfaction. PEER-REVIEW/ACADEMIA 61% 61% 31% 13% 31% 31% 31% Cost Reductions FewerEDVisits FewerInpatient Admissions Fewer Readmissions Improvementin PopulationHealth Improved Access Improvement Satisfaction IncreaseinPreventive Services INDUSTRY REPORTS (n= 13) (n= 8) (n= 4) (n= 1) (n= 4) (n= 4) (n= 4) 23% (n= 3) Total Studies (n= 8) Reported outcomes 1. PCMH studies continue to demonstrate impressive imp range of categories including: cost, utilization, popula access to care, and patient satisfaction, while a gap s on clinician satisfaction. Cost Reductions Fewer EDVisits Fewer Inpatient Admissions Fewer Readmissions Improvem Population Total Studies • Savings of $26.37 PMPM • $155 million in cost savings Source: Blue Cross Blue Shield of Michigan. Patient-Centered Medical Home Fact Sheet. July 2013. Retrieved from http://www.valuepartnerships.com/wp- content/uploads/2013/07/2013-PCMH-Fact-Sheet.pdf. • Develop patient registries to track and monitor patients’ care • Offer 24-hour patient access to a clinical decision-maker through • extended office hours • telephone access • a linkage to urgent care • Provide online patient resources that allow for electronic communication and greater patient access to medical information
  • 35.
    UPMC Health PlanMedical Home Pilot Pennsylvania 23,390 patients ResultsPCMH Strategies • 2.6% reduction in total costs • 160% ROI • 2.8% fewer inpatient admission • 6.6% increase in patients with controlled HbA1c 1. PCMH studies continue to demonstrate impressive improvements across a broad range of categories including: cost, utilization, population health, prevention, access to care, and patient satisfaction, while a gap still exists in reporting impa on clinician satisfaction. • Decreases in the cost of care, • Reductions in the use of unnecessary or avoidable services, PEER-REVIEW/ACADEMIA 61% 61% 31% 13% 31% 31% 31% 57% 57% 57% 29% 29% 14% 29% Cost Reductions Fewer EDVisits Fewer Inpatient Admissions Fewer Readmissions Improvement in PopulationHealth Improved Access Improveme Satisfact IncreaseinPreventive Services INDUSTRY REPO RTS (n= 13) (n= 8) (n= 4) (n= 1) (n= 4) (n= 4) (n= 4) (n= 4) (n= 4) (n= 4) (n= 2) (n= 2) (n= 1) (n= 2) 23% 14% (n= 3 (n= 1 Total Studies (n= 7) (n= 8) Reported outcomes Reported outcomes PAGE 6 1. PCMH studies continue to demonstrate impressive improveme range of categories including: cost, utilization, population he access to care, and patient satisfaction, while a gap still exist on clinician satisfaction. • Decreases in the cost of care, • Reductions in the use of unnecessary or avoidable services, PEER-REVIEW/ACADEMIA 61% 61% 31% 13% 31% 31 57% 57% 57% 29% 29% 14 Cost Reductions Fewer EDVisits Fewer Inpatient Admissions Fewer Readmissions Improvement in PopulationHealth Imp Ac INDUSTRY REPO RTS (n= 13) (n= 8) (n= 4) (n= 1) (n= 4) (n (n= 4) (n= 4) (n= 4) (n= 2) (n= 2) (n Total Studies (n= 7) (n= 8) Reported outcomes Reported outcomes 1. PCMH studies continue to demonstrate impressive improvements across a broad range of categories including: cost, utilization, population health, prevention, access to care, and patient satisfaction, while a gap still exists in reporting impact on clinician satisfaction. PEER-REVIEW/ACADEMIA 61% 61% 31% 13% 31% 31% 31% 57% 57% 57% 29% 29% 14% 29% Cost Reductions Fewer EDVisits Fewer Inpatient Admissions Fewer Readmissions Improvement in PopulationHealth Improved Access Improvement in Satisfaction IncreaseinPreventive Services INDUSTRY REPORTS (n= 13) (n= 8) (n= 4) (n= 1) (n= 4) (n= 4) (n= 4) (n= 4) (n= 4) (n= 4) (n= 2) (n= 2) (n= 1) (n= 2) 23% 14% (n= 3) (n= 1) Total Studies (n= 7) (n= 8) Reported outcomes Reported outcomes CMH studies continue to demonstrate impressive improvements across a broad ange of categories including: cost, utilization, population health, prevention, ccess to care, and patient satisfaction, while a gap still exists in reporting impact n clinician satisfaction. EVIEW/ACADEMIA 61% 61% 31% 13% 31% 31% 31% Cost Reductions Fewer EDVisits Fewer Inpatient Admissions Fewer Readmissions Improvement in PopulationHealth Improved Access Improvement in Satisfaction IncreaseinPreventive Services TRY REPORTS (n= 13) (n= 8) (n= 4) (n= 1) (n= 4) (n= 4) (n= 4) 23% (n= 3) Total Studies (n= 8) ted mes 1. PCMH studies continue to demonstrate impressive improvements across a broad range of categories including: cost, utilization, population health, prevention, access to care, and patient satisfaction, while a gap still exists in reporting impact on clinician satisfaction. PEER-REVIEW/ACADEMIA 61% 61% 31% 13% 31% 31% 31% 57% 57% 57% 29% 29% 14% 29% Cost Reductions Fewer EDVisits FewerInpatient Admissions Fewer Readmissions Improvement in PopulationHealth Improved Access Improvement in Satisfaction IncreaseinPreventive Services INDUSTRY REPORTS (n= 13) (n= 8) (n= 4) (n= 1) (n= 4) (n= 4) (n= 4) (n= 4) (n= 4) (n= 4) (n= 2) (n= 2) (n= 1) (n= 2) 23% 14% (n= 3) (n= 1) Total Studies (n= 7) (n= 8) Reported outcomes Reported outcomes • 18.3% fewer hospital readmissions • 23.2% increase in eye exams • 9.7% increase in LDL screenings • Practice-based nurses provide care management • Create telehealth options for care managers to connect to patients when in-office visits are not possible or necessary • Offer incentives to payers to enter into PCMH contracts Source: Rosenberg, C.N., Peele, P., Keyser, D., McAnallen, S., & Holder, D. (2012) Results from a patient-centered medical home pilot at UPMC Health Plan hold lessons for broader adoption of the model. Health Affairs. 31(11).
  • 36.
    CareFirst BlueCross BlueShield Maryland Maryland 1million patients ResultsPCMH Strategies • $98 million in total cost savings • 4.7% lower costs for physicians that received an incentive award 1. PCMH studies continue to demonstrate impres range of categories including: cost, utilization access to care, and patient satisfaction, while on clinician satisfaction. PEER-REVIEW/ACADEMIA 61% 61% 31% 13% 57% 57% 57% 29% Cost Reductions Fewer EDVisits Fewer Inpatient Admissions Fewer Readmissi INDUSTRY REPO RTS (n= 13) (n= 8) (n= 4) (n= 1 (n= 4) (n= 4) (n= 4) (n= 2 Total Studies (n= 7) (n= 8) Reported outcomes Reported outcomes ontinue to demonstrate impressive improvements across a broad ories including: cost, utilization, population health, prevention, and patient satisfaction, while a gap still exists in reporting impa isfaction. 61% 61% 31% 13% 31% 31% 31% Cost Reductions Fewer EDVisits Fewer Inpatient Admissions Fewer Readmissions Improvement in PopulationHealth Improved Access Improveme Satisfact IncreaseinPreventive Services (n= 8) (n= 4) (n= 1) (n= 4) (n= 4) (n= 4) 23% (n= 3(n= 8) • 3.7% higher quality scores for panels that received incentives • Quality scores for PCMH panels rose by 9.3% from 2011 to 2012 Source: CareFirst Blue Cross Blue Shield. Patient-centered medical home program trims expected health care costs by $98 million in second year. Press Release, June 2013. Retrieved from https://member.carefirst.com/wps/portal/!ut/p/c4/04_SB8K8xLLM9MSSzPy8xBz9CP0os3hLbzN_Q09LYwN • Use local care coordination teams to track high-risk members • Create an infrastructure for nursing support, easily- accessible online tools and data, and targeted health programs • Offer increased reimbursements to physicians based on performance in the program
  • 37.
    Oregon Health Authority CoordinatedCare Organizations (CCOs) Statewide Medicaid program 600,000 patients ResultsPCMH Strategies • 9% reduction in ED visits • 14-29% fewer ED visits for chronic disease patients • 12% fewer hospital readmissions • 18% reduction in ED visit spending • Reduced per capital health spending growth by >1% 1. PCMH studies continue to demonstrate impressive improvements range of categories including: cost, utilization, population health access to care, and patient satisfaction, while a gap still exists in on clinician satisfaction. • Decreases in the cost of care, PEER-REVIEW/ACADEMIA 61% 61% 31% 13% 31% 31% 57% 57% 57% 29% 29% 14% Cost Reductions Fewer EDVisits Fewer Inpatient Admissions Fewer Readmissions Improvement in PopulationHealth Improved Access INDUSTRY REPORTS (n= 13) (n= 8) (n= 4) (n= 1) (n= 4) (n= 4) (n= 4) (n= 4) (n= 4) (n= 2) (n= 2) (n= 1) Total Studies (n= 7) (n= 8) Reported outcomes Reported outcomes 1. PCMH studies continue to demonstrate impressive improvements across a broad range of categories including: cost, utilization, population health, prevention, access to care, and patient satisfaction, while a gap still exists in reporting impact on clinician satisfaction. PEER-REVIEW/ACADEMIA 61% 61% 31% 13% 31% 31% 31% 57% 57% 57% 29% 29% 14% 29% Cost Reductions Fewer EDVisits Fewer Inpatient Admissions Fewer Readmissions Improvement in PopulationHealth Improved Access Improvement in Satisfaction IncreaseinPreventive Services INDUSTRY REPORTS (n= 13) (n= 8) (n= 4) (n= 1) (n= 4) (n= 4) (n= 4) (n= 4) (n= 4) (n= 4) (n= 2) (n= 2) (n= 1) (n= 2) 23% 14% (n= 3) (n= 1) Total Studies (n= 7) (n= 8) Reported outcomes Reported outcomes 1. PCMH studies continue to demonstrate impressive impr range of categories including: cost, utilization, populat access to care, and patient satisfaction, while a gap st on clinician satisfaction. PEER-REVIEW/ACADEMIA 61% 61% 31% 13% 31% Cost Reductions Fewer EDVisits Fewer Inpatient Admissions Fewer Readmissions Improvemen PopulationHe (n= 13) Total Studies Reported outcomes Source: Oregon Health Authority. (2013). Oregon’s Health System Transformation: Quarterly Progress Report. Retrieved from http://www.oregon.gov/oha/Metrics/Documents/report-november-2013.pdf. • Establish a primary care infrastructure that includes 450 PCMH practices and clinics • Increase the use of outpatient care to promote prevention • Increase well-care visits to adolescents to reduce unnecessary ED visits • Provide follow-up care to patients within 7 days of being discharged
  • 38.
    The Challenge ofStudying the PCMH: The Right Metrics? • Right metrics? – Gap in clinician satisfaction measures – tied to workforce needs – Need for better/more patient satisfaction measures of self-reported health status/well-being – Measures need to account for patient diversity, socioeconomics and social determinants of health – Need for standard core measures – including behavioral health and oral health integration – Stronger case for connection to health equity
  • 39.
    • Right methods? –Study designs appropriate for investigating complexity of health system reforms – Recognition that the model/philosophy is evolving – Evaluation often in the midst of multimodal change processes Source: Grumbach, Kevin. "The Patient-Centered Medical Home Is Not a Pill: Implications for Evaluating Primary Care Reforms." JAMA internal medicine 173.20 (2013): 1913-1914. The Challenge of Studying the PCMH: The Right Methods?
  • 40.
    Take Home Points PCMHevaluations over the past year reported significant improvements across a broad range of clinical and financial outcomes The PCMH is playing an increasingly critical role in delivery system reform, including ACOs and the medical neighborhood Significant payment reforms continue to incorporate the PCMH
  • 41.
    Thank You! Contact: J. NwandoOlayiwola, MD, MPH, FAAFP Associate Director, Center for Excellence in Primary Care University of California, San Francisco OlayiwolaJ@fcm.ucsf.edu Twitter: @DrNwando (415) 206-2970 (O)

Editor's Notes

  • #9 Over 150 are Federally qualified health Centers 11.5 percent of all physicians