Tech-enabled medical homes squeeze out care costs

Key Points

THE CENTRAL INGREDIENT of the patient-centered medical home (PCMH) model is information. Data flows among primary care physicians (PCPs), specialists and other providers, theoretically providing access to complete clinical information for each patient to make the most informed treatment decision.

Much hope has been placed on the PCMH concept. The healthcare industry and federal government are allocating millions of dollars in funding to show that it can deliver better care. Many health plans are implementing multiple pilots, and innovative primary care practices are participating in programs with one or more plans.

The Patient Protection and Affordable Care Act expands PCMH pilot projects, and providers are negotiating with the federal government to allow PCMH pilots to qualify for incentives under Meaningful Use.

Additionally, nearly 45 states and the District of Columbia have passed more than 330 pieces of legislation related to the PCMH model, according to the Patient Centered Primary Care Collaborative. Federal agencies such as the Department of Veterans Affairs are pursuing PCMH demonstration projects.

Employers, too, are supporting the concept with their insurance carriers.

"It will continue to mature and take shape in the coming years as we see what works," says Shannon Nelson, national director of patient centered medical home and e-prescribing programs for UnitedHealthcare, which has five pilot models ongoing across the country.

SHARING INFORMATION IS VITAL

Since information is critical to the success of a PCMH, it needs to be instantaneously accessible to the provider team. Supporters emphasize that a successful PCMH implementation requires a robust health information technology solution, including electronic health records (EHRs), personal health records (PHRs), and e-prescribing.

"The team has to be able to share information," Dr. Fischer says. "It is tough to do that without technology."

Data that a provider enters into an EHR and data that a patient enters into a PHR complement each other to create a complete, accurate clinical picture. Clinical decision-support technology turns the raw data from EHRs and PHRs into useful, actionable information that doctors and patients can use to improve care.

"It is an attempt to move the doctor-patient paradigm from a reactive state to where a doctor can proactively identify patients at risk and put procedures in place to prevent problems," says Gregory Steinberg, MD, CEO and president of ActiveHealth Management, an independent subsidiary of Aetna and provider of health management services. "Having a PCMH in place leverages an individual physician to provide high-quality medical care to a much greater number of patients."

Can the PCMH model work in a paper-based environment?

"You can't get to the medical home model unless you have technology," Keckley says. "You can't improve patient care without managing information."

And you can't drive improved outcomes without information technology, says Thomas Simmer, MD, senior vice president and chief medical officer, Blue Cross Blue Shield of Michigan.

For example, electronic records give providers the ability to look across patient populations to identify those who may be due for screenings, says Phyllis Torda, vice president of the Strategic and Quality Solutions Group for the National Committee for Quality Assurance (NCQA).

Proactive care is the main goal, of course. A recent study found women taking estrogen and progestin had an increased risk of breast cancer. In that case, Torda says a technologically functional PCMH would allow providers to identify patients on such therapies, allowing for quick communication.

"They can bring the patients in to discuss the new research and whether a new treatment course is appropriate," she says.