Why Pursue PCMH Recognition? Three Benefits to Consider

    Posted by Lauri Miro on Jan 27, 2016 11:18:11 AM
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    The following post was written by Lauri M. Miro, MBA, RN, PCMH CCE and Dale L. Gentz, MBA, PCMH CCE of the Halley Consulting Group.


    With population risk shifting to healthcare providers, interest in patient-centered care is increasing. Healthcare systems that have not yet done so should examine the benefits of having their owned and affiliated primary care practices become formally recognized as patient-centered medical homes (PCMHs). For some organizations, achieving this recognition involves a significant commitment to change, both with regard to workflows and to the organizational culture at large—but in most cases, the long-term benefits far outweigh the initial work required.

    If you’ve considered pursuing formal PCMH recognition for your hospital-owned and affiliated PCP practices—and even if you haven’t—here are three reasons you should take action and work toward achieving this status.


    1. Higher Patient Satisfaction and Engagement

    Improvement in the health of populations requires a higher level of patient engagement than ever before. The PCMH model encourages patients to take responsibility for their care by actively engaging and educating them, and by assessing their knowledge. When patients are well informed, they can share in decision making and be in a position to make the best healthcare choices from among multiple options. Providers who empower patients in this manner send the message that patients can take charge of their health instead of passively receiving medical services.

    In addition to engaging patients in their own care, PCMH-recognized practices have the potential to improve patient satisfaction by providing:

    • Enhanced access after-hours and online
    • Long-term provider relationships
    • Continuity of care
    • Better quality and experience of care

    Each year, the Patient-Centered Primary Care Collaborative examines and reports on the results of peer-reviewed studies, governmental program evaluations, and industry reports about the efficacy of the PCMH model. Studies in the most recent report found improvements in patient satisfaction and quality, along with utilization and cost.


    2. Improved Clinical Quality and Coordination of Care

    The PCMH model challenges primary care practices to enhance the quality and coordination of care by improving access and promoting teamwork. Same-day access for routine and acute visits is rapidly becoming the accepted standard of care. The PCMH model emphasizes team-based care and advocates the use of patient-care team meetings or other daily modes of communication in each practice to review patients’ history and coordinate their care. Another key PCMH requirement is putting systems in place to coordinate patients’ care among various providers and service points outside the primary care practice. Without such coordination, service delivery often becomes fragmented, and each provider along the care continuum is unlikely to understand the full patient picture.

    A recent study highlighted the benefits for providers of patient-centered primary care by comparing medical claims for more than 17,000 patients in 27 small primary care medical homes with 29 traditional small primary care practices. The results for PCMHs included statistically significant higher performance in several areas, including process measures in diabetes care and breast cancer screening; fewer ambulatory visits to specialists; fewer ED visits; and lower hospitalization rates.


    3. Potential Opportunity for Higher Reimbursement

    Looking ahead, the Department of Health and Human Services (HHS) has set a goal to tie 30 percent of Medicare payments to alternative payment models such as accountable care organizations, patient-centered medical homes, and bundled payments by the end of 2016, and 50 percent by the end of 2018. According to the Centers for Medicare and Medicaid Services, the intention behind this goal is “to help drive the health care system toward greater value-based purchasing—rather than continuing to reward volume regardless of quality of care delivered.”

    Because Fee for Service (FFS) payments can still be highly profitable, some healthcare delivery systems remain hesitant to fully transition their infrastructure for Value-Based Reimbursement (VBR). However, most payers are actively evolving their future payment methodologies for VBR, and organizations that are not actively preparing may be unable to achieve full reimbursement potential in the future. Within the next three years, it is projected that well over 50 percent of reimbursement could be value-based.


    A growing body of evidence documents that PCMHs improve the quality, cost, and experience of care, and more than 10 percent of U.S. primary care practices already meet rigorous National Committee for Quality Assurance (NCQA) criteria for designation as PCMHs.

    To effect positive change in the health of populations, healthcare systems must take steps to more fully engage patients in their own healthcare. Primary care practices are in an ideal position to ensure that care delivered within an integrated delivery system is truly patient-centered and collaborative. While achieving PCMH recognition and true practice transformation involves a significant investment in resources, it is becoming increasingly evident that the investment will yield a positive return.



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