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Efforts to Implement PCMH Concepts Can Lead to Big Cost Savings for States
As 1 of 8 states to conduct a Multi-Payer Advanced Primary Care Practice (MAPCP) demonstration project aimed to evaluate the effectiveness of patient-centered medical homes (PCMHs) when Medicaid, Medicare, and private payers support it, North Carolina and Community Care of North Carolina (CCNC) found that over a 4-year period, efforts to implement PCMH concepts saved the state an estimated $1 billion, and according to a presentation at the PCMH Congress, this kind of success is possible in other states.
R.W. “Chip” Watkins, MD, MPH, FAAFP, senior physician consultant, CCNC, believes innovative partnerships and strategies have helped CCNC make a successful transformation to value-based care.
“For us, at CCNC who are really the vendor for Medicaid, it allows us to kind of put our toe into the water of a multi-payer project,” Dr Watkins said after the conference session.
According to the Centers for Medicare & Medicaid Services, the MAPCP demonstration, started in 2011, included Maine, Michigan, Minnesota, New York, North Carolina, Pennsylvania, Rhode Island, and Vermont. Initially planned to last for 3 years, each project is conducted and coordinated by the participating state and includes Medicaid and substantial participation by private health insurers
A monthly care management fee for beneficiaries receiving primary care from advanced primary care (APC) practices is paid for by the demonstration program, and is intended to cover care coordination, improved access, patient education, and other services to support chronically ill patients.
Patient-centered medical homes have been shown to have a significant impact on quality outcomes and cost savings. An examination of outcomes for 7 medical home demonstrations found that there was a 15% to 50% decrease in emergency room visits, a 6% to 24% decrease in hospital admissions, lower mortality rates, better chronic disease care, better preventive service delivery, and higher patient satisfaction. The report also found that PCMHs resulted in a lower total cost of care by 6.5% to 22%, shorter patient wait times, less staff burnout, and higher staff satisfaction/productivity (Nielson et al. The Medical Home’s Impact on Cost & Quality: An Annual Update of the Evidence, 2012-2013. Patient-Centered Primary Care Collaborative. January 2014).
Dr Watkins says the PCMH is just one of several things practices can do, such as implementing elec- tronic health records (EHRs) or e-prescribing, to move toward more quality-based care.
“All of these things help these practices prepare for the future and PCMH is certainly one of those, I would say foundational things, for being able to participate in an ACO [accountable care organization] or clinically integrated network in an area. You’ve got to be able to do quality work and you’ve got to be able to report it,” he says.
But, despite the increased quality outcomes seen with PCMH models, Dr Watkins, who also serves as senior medical director at Community Care Western North Carolina, says obstacles, such as time, resources, and fear of government interference or change, could be preventing practices from implementing these value-based ideas.
Since CCNC has begun PCMH support for the MAPCP demo, the number of PCMH practices has been steadily on the rise in North Carolina, now topping more than 500.
According to Dr Watkins, it’s important that practices begin making steps toward quality-based initiatives now as more metrics are moving toward quality-based care. For example, for the first time in its history the US Department of Health & Human Services (HHS) set specific goals for Medicare related to alternative and value-based payment models. They hope to tie 30% of traditional or fee-for-service Medicare patients to alternative payment models by the end of 2016 and move to 50% by the end of 2018.
To successfully make the shift, Dr Watkins believes that the sole responsibility will no longer be able to fall on primary care physicians and will instead need to include specialists as well. The PCMH and patient-centered specialty practice concepts should help control costs by including specialists in the process.
According to Dr Watkins, specialists will be required to agree to appropriate quality metrics and must be able to track and monitor data related to referrals as well as lab and monitoring costs.
“The specialists are going to have to use their EHRs meaningfully, they are going to have to be able to do quality work, they are going to have to be able to report that to the ACO or the clinically integrated network of which they are a part, and by doing so, that’s going to lower costs,” he says.
In the years ahead, Dr Watkins says doctors need to be prepared for the way they are going to get paid to change dramatically. As a result, small and independent practices must adopt cost- sharing and cost-saving strategies to stay financially solvent, he says. Practices need to begin making the switch from volume to value.
After talking with practicing physicians about their impressions of PCMH and quality-based initiatives, Dr Watkins shared that while physicians reported they liked having checklists to improve the completeness of care, improve efficiency, and point out practices limitations, it can take more time and money.—Jill Sederstrom
