Value-based care

How can an IPA Transform into a PCMH?

Paul Grundy
Mon 30 July 2018

Recent initiatives by the US government executives and legislative branches to reward value over volume are nothing short of a truly historic shift in the US healthcare. These initiatives are facilitating the rise of different business, delivery, and clinical models. Amid all of them, the importance of primary care has evolved from merely being the patient’s first touchpoint in the care continuum to the central player in an integrated landscape.

Many healthcare leaders agree that stronger primary care is key to successful outcomes, and are transforming their practices into patient-centered medical homes (PCMHs). Nearly 7,000 primary care practices are accredited as PCMHs, and are exemplary embodiments of optimized care coordination and patient engagement.

Transforming into a PCMH is a major undertaking and requires the right organizational architecture to be implemented successfully. A good model can be found in independent physician associations (IPAs), as they offer best practices for integrated care from their long history of operating as a network.

Challenges IPAs face as they switch to PCMH

Becoming a PCMH is more than signing up or a changing the way in which a practice is reimbursed. There exists certain prerequisites as practices begin their switch to a PCMH:

Reorganizing how care is delivered: PCMH is entirely centered around the idea of coordinated and holistic care driven largely by PCPs. This requires significant shuffling of roles, tying PCPs and specialists together, and increased focus on family and
community medicine.
Additional cost incurred during transformation: PCMH requires investment in reorganizing the practice’s structure and creating data-powered workflows to optimize the practice’s operations. The more empowered PCPs are in a PCMH, the more
successful it is.
Coordinating care for high-risk patients: The current healthcare system is designed to treat the sick, and not provide holistic care with a ‘whole person’ approach. But with 80% of the US healthcare costs driven by chronic conditions, PCMHs need to enforce an integrated mechanism to coordinate care.

The first step: becoming patient-centric

Patient-centered medical home: the name says it all. The first challenge in creating a successful PCMH is to enhance the focus on individual patients. A successful PCMH is one where the primary care physician, the specialists, and the entire care team steps up to improve the patient-physician relationship. It is a facility that delivers population health management, patient-centered prevention, and coordinated care across an integrated system. None of this is possible if the patient is kept out of the loop.

Holistic and coordinated care requires different entities of healthcare to collaborate their efforts and to help the patient navigate throughout the care journey. The patient shouldn’t shuffle around across clinics, labs, EDs, with their reports, answering the same set of questions or undergoing examinations over and over again.

Switching to PCMH requires cultivating a better patient-physician relationship. As the first touchpoint of a patient across the continuum, the PCP can learn more about the patient’s health and their lifestyle to understand the barriers they experience. Additionally, this will help in educating patients and the members of the care team to coordinate care even when the patient leaves the doctor’s office.

Transforming to PCMH must be technology-driven

Becoming a PCMH is majorly about a changing the practice philosophy and how care is delivered, and technology is an instrumental part of it. The Department of Health and Human Services suggests that practices aiming to become a PCMH need to have some or all of the technology components below:
● Electronic health records
● Patient health records: helping patients and their caregivers access and manage health information
● Patient portal
● Provider portal: tracking their patients’ referrals and consultations with other providers
● Payer portal: collaborating with payers to address insurance issues electronically
● Telehealth

But the need for technology in a PCMH approach goes beyond guidelines. As patient health becomes a patchwork of many entities working in silos, technology is required to build a unified platform that brings these entities together and enable coordination. And most importantly, technology has to be the enabler of how a patient is empowered to approach their provider and take control of their health.

An efficient data-driven solution could be instrumental in many ways as it can:
● Enable real-time information flow across different practices
● Analyze population health and gaps in individual care
● Monitor network utilization and expenditure
● Track out-of-network activities
● Schedule referrals and monitor patient no-shows

A roadmap to becoming an efficient PCMH

Here’s how a practice can tailor their operations to transform into a PCMH:

● Increase the use of health IT to improve the quality of care provided by member participants while improving population health
● Improve data collection, analysis, and reporting among member participants to enhance the use of accurate and quality-based data to drive high performance
● Increase the secure electronic data exchange between providers and related healthcare organizations to support the delivery of coordinated health care through a patient-centered model and regular transmission of the quality improvement data to the MCOs
● Improve clinical and operational performance of member participants while advancing the implementation and operationalization of patient-centered medical homes (PCMH)

The key is to empower physicians

No matter how many transformations, it’s the primary care physician who has to deliver care to patients in a PCMH. As primary care physicians take on more responsibility of improving patient health and coordinating care, they need to be focusing on the patient and not the mounds of deskwork around them. For every hour physicians spend on seeing patients, they spend an extra two hours on paperwork. The Annals of Internal Medicine found that, for a physician, 49.2% of the time goes into doing paperwork- which includes EHRs.

Physicians have to be delivered actionable information- just what they need to know about the patient sitting before them. The care gaps for the patient, the codes that were dropped against them, the missed screenings- all of this should be easily accessible to the physician. The fragmented information, combined with overwhelming drop-down menus and manual data inputs lead to burned-out physicians and poor patient care.

It is important that the physicians don’t spend their entire day just looking for information. PCPs have a greater role in a PCMH, and they need to be provided with crisp, action-ready information that reduces their burden and leaves them to drive patient care.

PCMH is a marathon, not a sprint

Becoming a PCMH is not a destination. It is about having an ongoing focus on patient care, and requires continuous improvement. Not just from a quality standpoint, it’s about critical to understand healthcare resources are precious resources and need to be managed efficiently. Most importantly, it’s about making the patient the center of the care. As the entire healthcare looks for ways to cut down their expenditure and bring primary care at the nexus of US healthcare, PCMHs might just be the answer!

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