Why Investment in Primary Care Through PCMH Utilization is Important

Ann Greiner, MCP, president and CEO of Patient Centered Primary Care Collaborative, Washington, DC, kicked off the first session of PCMH Congress 2019.

Ms Greiner first explained that primary care is being reinvented with PCMH. She said that the initial partnership was between employers and physician specialty societies, and now there is a broadened coalition. She highlighted the launch of the Patient-Centered Primary Care Collaborative.

“What is PCMH [Patient-Centered Medical Home]?” Ms Greiner asked.  

“It’s not a place, it’s a partnership with your primary care provider,” she said.

Ms Greiner explained, “PCMH puts you at the center of your care, working with your health care team to create a personalized plan for reaching your goals. Your primary care team is focused on getting to know you and earning your trust.”

She explained that technology is helpful in these partnerships, noting that it makes it easier to get health care when and how patients need it. Currently, patients have the option to reach their doctors via email, video chat, and via after-hour phone calls.  

Ms Greiner shifted her presentation to highlight PCMH growth for conference attendees.

“PCMHs grew rapidly,” she said. “Commercial health plans really increased adoption of PCMH.”

According to Ms Greiner, states across the country “took up the mantle.” She said that there are currently 13,000 NCQA-recognized practices in the United States.

Ms Greiner said that more than 20% of primary care providers currently practice in a PCMH. Based on evidence reports conducted, she said that PCMHs improve value and are associated with better quality and lower cost.

“We also found that PCMHs that were in existence for 4 to 5 years achieved this,” she said.

According to data from peer-reviewed articles, the impact of PCMH utilization showed positive results in the following categories:

• Cost;
• Quality;
• Inpatient utilization;
• Emergency department utilization; and,
• PCP utilization.

Along with these positive results, Ms Greiner said that accountable care organization success is also linked to a PCMH.

“Physician-run ACOs do better,” she told conference attendees. “ACOs with higher prevalence with PCMH do better with controlling costs.”

Although PCMH enhances primary care, Ms Greiner said that the model is still underpowered. She said that there is an insufficient investment in primary care/PCMH, and more primary care practices are still paid on a fee-for-service basis. However, she explained that there was a primary care investment campaign that launched in January 2018 and two states had passed legislation at this time.

“States have authority to set spending priorities,” she said, “and now we have a more robust evidence base...to date, 10 states have introduced or passed legislation.”

In 2019 alone, five states, including Colorado, Maine, Vermont, Washington, and West Virginia, have passed legislation that largely focus on reporting primary care spending levels. Further, two states have set targets for primary care investment, including Rhode Island (10.7%) and Oregon (12%).

“Rhode Island has achieved those targets,” Ms Greiner said. “What we’ve learned is states come to this for different motivation.”

She explained that states have different starting points with respect to advanced primary care, including PCMH. “If we spend more, we’re going to get better outcomes.”  

“I hope people join with us! We really need all of you,” she expressed. “You will be more successful in what you do if there is more investment.” —Julie Gould