“Patient-centered medical home” is a model of health care that is gaining momentum among physicians and favor among patients. Though the concept predates the Affordable Care Act by many years, the act has created an urgency for adoption of the model by physicians and their practices and acceptance by patients and their families.
The Pennsylvania Academy of Family Physicians has adopted the PCMH as a major focus of its mission, with its “emphasis on coordinated care, quality, safety, and a more robust patient-physician relationship.” Both the Pennsylvania and American Academies of Family Physicians note that medical practices that follow the PCMH model of care “seek to improve the quality, effectiveness and efficiency” of care “while responding to each patient’s unique needs and preferences.”
A PCMH emphasizes the partnership between a patient and team of caregivers led by a primary care physician. In such a practice, patients actively engage in their health education and treatment. Though the PCMH concept dates back to the mid 1960s, a fairly recent convergence of culture, technology and economics has thrust the PCMH into the health care limelight.
For many generations in America, patient care was top-down, with the physician in charge and the patient generally heeding the physician’s every word. All services were provided directly by the physician. While such a professional approach is admirable, in reality it is not always effective — or efficient. Today’s patients are more autonomous and knowledgeable, and most have a wealth of medical knowledge at their fingertips via the Internet. In a PCMH practice, patients are regarded as part of the health care team, along with their nurses and other caregivers, under the direction of their primary care physician.
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This team approach and greater participation in one’s own care is particularly vital for patients who have chronic conditions or are seriously ill — a major focus of the PCMH. Patients with chronic conditions and advanced illnesses account for 10 percent of the U.S. population but 80 percent of health care costs.
In central Pennsylvania, nearly 300,000 Highmark members receive PCMH care at 300 participating medical practices. There, physicians and practice staff provide patients and families with greater support for patient education, understanding treatment options and decision making. At the same time, PCMH practices utilize health information technology, like electronic medical records, to better monitor and manage patient conditions.
Highmark Inc.’s 2-year-old PCMH program is showing positive results with measured improvements in patient care. For example, we’re seeing lower emergency room use, fewer hospital readmissions and a clear trend in cost savings.
Our PCMH outcomes from central and western Pennsylvania illustrate that both the quality and efficiency of patient care have progressed significantly since the program was implemented:
• Emergency room utilization is lower than the market by 15.7 percent (adult care), 14 percent (Medicare Advantage) and 12.6 percent (pediatric care).
• Readmission rates for members are lower than comparative market rates by 1 and 2 percent, respectively.
• Prescription drug use is 6.6 percent lower than the market, while the market trend is increasing by 1.6 percent. Inpatient surgical utilization is 12 percent lower (adult care) and 9 percent lower (Medicare Advantage) than the market.
• Inpatient medical utilization for Medicare Advantage members is lower than the market by 25.8 percent.
• And, nationally accepted measures of quality have improved by more than 30 percent.
Care costs and care cost trends have also decreased. We reward our PCMH practices for improving the value of care delivery — improving outcomes at lower costs. This pay-for-value approach has been linked to better provider-facility communications, fewer unnecessary tests, enhanced online patient services, evidence-based treatments and better patient access to care.
Following the success with our participating PCMH practices, beginning in 2015, we are offering an insurance plan that reduces costs for members who choose practices providing PCMH care.
Patient-centered medical homes are not a here today-gone tomorrow trend. They’re here to stay because they’re effective. They improve patient care and conserve valuable health care resources. Our PCMH experience has clearly illustrated that working together, patients, physicians, practice staff and insurers can increase the quality of patient care, lower health care costs and improve the overall patient experience.