How can providers overcome the challenges of creating the patient-centered medical home?
- There are a lot of good things to be said for the patient-centered medical home (PCMH) model, which has been credited with reducing healthcare costs, boosting the delivery of preventative services, and improving care coordination with patients who may have complex chronic disease management needs. But transforming the average healthcare organization into a PCMH and achieving the official designation can be a challenging proposition.
Why should providers consider the PCMH model, and what barriers might stand in their way?
Benefit #1: There is mounting evidence that the PCMH is effective for reducing costs through better care coordination and improved data exchange
A number of case studies and academic reviews have shown that the PCMH can reduce spending and produce a significant return on investment. Colorado’s Multi-Payer PCMH Pilot cut emergency department visits by 15 percent and inpatient admissions by 18 percent while achieving a return on investment of 4.5 dollars for every dollar spent. In Maryland, a PCMH program saved $98 million and raised quality scores by nearly 10 percent in just one year.
Challenge #1: Ensuring that patients come to the PCMH first requires high levels of education, engagement, and satisfaction with the healthcare provider
The evidence may be there, but how do providers achieve similar results? The first step is one of the hardest: turning reluctant patients into engaged partners in their own care. Engaged patients are more likely to turn to their primary care provider instead of the emergency room, or to take their medications properly to manage conditions that might otherwise land them in the hospital.
To create a culture of engagement, providers must listen to the patient voice and understand their population in order to implement effective strategies for maintaining a positive conversation. The Patient Experience Council (PXC) recommends that providers initially conduct assessments of their patients’ capabilities to engage with their own care and then provide patients with access to their data, and responsibilities for decision making according to their capacity to effectively leverage the patient-provider relationship.
Benefit #2: A reliance on EHRs, clinical analytics, and other health IT can produce a rich portrait of population health to help pinpoint areas of concern and opportunity
One of the key features of the PCMH model is the ability and necessity to monitor patients between appointments as closely as when they come into the office. A sophisticated health IT infrastructure is necessary to provide automated patient reminders, exchange health information with other partners on the care continuum, and conduct risk stratification that allows providers to allocate resources to the neediest of their patients. These technologies have long been associated with better quality of care and improved patient safety, but they require a level of commitment to data governance and a financial outlay that can be daunting.
Challenge #2: Creating a robust health IT infrastructure requires significant financial investment and strong buy-in from leadership and clinical staff
It’s no secret that achieving a fully integrated, interoperable, effective health IT ecosystem with all the bells and whistles of clinical decision support and predictive analytics is very difficult to do. It’s also very expensive. Providers may wish to invest in infrastructure a little bit at a time, which makes good money sense, but may also drag out the process for longer than is desirable.
Providers must also ensure that they are getting the data they think they’re getting from their clinical analytics systems, warns a new white paper from Accreditation Association for Ambulatory Health Care (AAAHC). “’Getting our information systems to provide useful population health data’ has been the greatest challenge at Eisenhower Argyros Health Center, said Joseph E. Scherger, MD, vice president, primary care. ‘Forming our teams, increasing patient communication and doing care coordination were not difficult … [but] our information systems lag behind our work processes.’”
The PCMH is a collaborative model on many levels, and requires investors, executives, and clinicians to be keenly aware of everyone else’s must-haves as well as their concerns. “The need for over-communication, development of new skills and teamwork cannot be underestimated,” the white paper states.
Benefit #3: The PCMH model encourages the application of high quality, evidence-based medicine and standardizes care around widely recognized best practices
Providers who investigate the PCMH likely already have an interest in applying best practices vetted by the industry to their own organization. At its heart, the PCMH “presents a different paradigm for delivering health care,” says the AAAHC, and that can be both a very good thing and a very difficult one. PCMH principles align with many of the other quality improvement and payment reform projects promoted by CMS and other expert groups, and can position healthcare organizations for greater success in a financially challenging landscape.
A provider can never go wrong with building stronger patient relationships, focusing on patient-centered care, and streamlining workflows to produce greater efficiencies, and the PCMH provides a clear and concise framework for achieving those improvements.
Challenge #3: Achieving accreditation takes dedication, time, and teamwork
However, the requirements for accreditation from the Joint Commission or the AAAHC can be a stretch for some organizations. And a total PCMH transformation can take up to a year and a half, says Michael Meucci, Director of Transformation and Improvement at Arcadia Healthcare Solutions, and keeping focused on the prize isn’t always easy with a slew of competing initiatives facing healthcare providers today.
“If you’re looking to get recognized by one of the accrediting bodies, you’re looking at a pile of documentation and reports that need to be collected and proofread and reviewed and the whole nine yards,” he says. “It can get lost in making sure that your physicians are hitting their meaningful use targets, or making sure that you’re hitting your quality targets for pay for performance contracts.”
“A lot of the transformation process is thinking and talking about what [can be done] differently,” Meucci adds. “Because there’s no such thing as a medical home that comes ready-made in a box. It looks different for every organization.”