St. Anthony’s creates PCMH model for primary care physician practices
St. Anthony’s Medical Center recently rolled out a Patient-Centered Medical Home pilot program to provide patients extended hours, expanded services and enhanced quality of care, thanks to Missouri Foundation for Health (MFH) funding for training, along with financial support from Anthem Blue Cross and Blue Shield, the first and only PCMH pilot project for the Missouri insurer.
Five primary care physician practices – members of St. Anthony’s Physician Organization (SAPO) – are participating in the pilot project designed to improve how healthcare is delivered.
“It’s setting a new standard of excellence for primary care,” said Ron Finnan, practice administrator for SAPO primary care physicians. “There are three levels of certification to become a Patient-Centered Medical Home, and we expect to reach Level 1 within 18 months.”
MFH, the largest nongovernmental funder of community health activities in Missouri, is providing $560,000 to fund intensive training for the five SAPO practices and 70 other Missouri practices participating in the 18-month project to transform the practices into certified medical homes. Other St. Louis area clinics receiving training funding include federally qualified health centers (FQHCs) and community mental health centers. Training began in St. Louis last December with the first of three “learning collaboratives” that will take place over the transformation timeline.
“A medical home creates durable and meaningful relationships among patients, families and their doctors’ care teams,” said MFH CEO Robert G Hughes, PhD. “The care is accessible, continuous and compassionate, and patients can become empowered and ultimately make healthier lifestyle decisions. The core elements of a medical home include better engaging the patient in managing medical conditions, being proactive in making sure patients get needed care, suggesting appropriate and compassionate treatment options, answering questions about illnesses, and coordinating the care ordered by specialists.”
Anthem is paying each practice a monthly allowance to cover the cost of services associated with creating a medical home, and also a monthly amount for clinical care management.
“The practice will be reimbursed a PMPM (per member per month) stipend, depending on the age of the patient,” explained Finnan, noting that 18 SAPO physicians, two physician assistants and two nurse practitioners comprise the core care delivery team.
Part of Anthem’s monthly payment funds a care manager at each practice, a registered nurse who helps coordinate every aspect of each patient’s care. Care managers may also help access community resources for patients and their families, such as securing financial assistance to pay for their medications, identifying therapy options in their neighborhoods, or checking on the availability of short-or long-term nursing home care.
“Members receive their highest level of benefits when they receive services from network physicians,” said Ruth Meyer Hollenback, Anthem’s vice president of health services, also noting that all referrals from St. Anthony’s physicians “should be to specialists in the Anthem Blue Cross and Blue Shield networks.”
Family practice specialist Damon Broyles, MD, of Fenton Family Medicine, and a SAPO physician certified to participate in the pilot program, said the PCMH model is a more focused approach to quality care, making patients and providers a unified healthcare team.
“We were already moving toward certain aspects of the PCMH model,” he said. “It’s designed to get everyone on board with electronic medical records (EMRs), and also to standardize some of the work flows within the EMR system and establish a framework for epidemiology, population-based management, and more tailored individual care for patients. With that framework, we had some practices in place. There are some areas of care delivery that will require more discussion and thought and change of work flow.”
The PCMH model of care will help reduce emergency department visits and the number and duration of hospital stays, and also eliminate duplicative procedures and testing.
With St. Louis being the asthma and allergy capitol of the United States, and a higher-than-average market of tobacco users, Broyles said some changes will implement patient support systems in a novel way.
“For example, the idea of group-based visits to enhance patients’ understanding of chronic illnesses is something we’re not doing now, but is a very good idea we’ll implement,” said Broyles. “That’s just one piece of the new model that will take multidisciplinary coordination of clinical and operational aspects, circling back to the primary goal of making medical home care even more beneficial for our patients.”
St. Anthony’s Physician Organization’s practice locations involved in the PCMH model:
Broyles said he’s pleased the PCMH movement has spurred policy conversations at the local and state level. “Our smoking cessation message should be more prevalent to reduce smoking-related illnesses,” he said.
The primary care specialty becomes all-encompassing, as the physician looks to treat the physical, emotional, mental, psychological, sociological, economic and spiritual needs of the patient, Finnan said.
“Can the physician, alone, provide all of this? Absolutely not,” he said. “But the physician can be the quarterback for the rest of the healthcare team. It’s a partnership among physician, care manager, staff, patient and family.”
The outcome of the Supreme Court decision due in June on aspects of Congress-passed healthcare reform won’t make a difference in St. Anthony’s pursuit of the PCMH model, said Finnan. (Healthcare reform didn’t mandate PCMHs; however, the law does require the formation of accountable care organizations (ACOs), which tie into PCMH models.)
“Healthcare reform is very broad, and the court ruling will definitely necessitate changes in the practice of medicine, whatever the outcome,” he said. “However, our plans to move toward the PCMH model won’t change.”
While the PCMH is unquestionably a more satisfying experience for the patient, it’s also a more fulfilling model of care for physicians, said Broyles.
“In the past, doctors were paid according to volume of patients,” he explained. “Now it’ll be based on the value provided to patients. It’s a way to deliver more personalized care to our patients. Additionally, patients who are involved in the process are more likely to be compliant and their treatment is more likely to be successful.”
RELATED STORY: Patient Centered Medical Home Certification Levels
The National Committee for Quality Assurance (NCQA) Accountable Care Organization (ACO) accreditation includes three levels, representing varying degrees of capability for coordinating care and reporting and improving quality.
Level 1: Indicates organizations that are in the formation/transformation stage but have not yet reached full ACO capability. They have the basic infrastructure and possess some of the capabilities outlined in the standards. The length of this status is two years, reflecting the expectation that organizations will be reevaluated to see if they have increased capabilities.
Level 2: This level indicates organizations with the best chance of achieving the triple aim. At this level, entities demonstrate a broad range of ACO capabilities. The length of this status is three years.
|Vital Role of the Care Manager in the Patient Centered Medical Home Model|
Level 3: This level indicates organizations that have achieved Level 2 status and demonstrate strong performance or significant improvement in measures across the triple aim. The length of this status is three years.
Under the Patient Centered Medical Home (PCMH) model that St. Anthony’s Physician Organization (SAPO) has adopted, the care manager’s responsibilities include:
- Advising patients regarding preventive care and helping them make healthy lifestyle decisions, to lessen their chances of developing serious health problems;
- Notifying patients regarding the need to schedule immunizations, screenings, lab work and other tests;
- Scheduling regular check-ups with the physicians to monitor the patient’s health and to prevent emergency procedures;
- Coordinating the patient’s care, whether in a specialist care setting or a community-based setting, using portable, up-to-date electronic medical records;
- Providing medical care accessibility 24/7, through a secure online patient portal, e-mail or telephone, so the patient can avoid a trip to an urgent care clinic or emergency department;
- Offering patient/family education, to ensure that they’re fully informed and to engage them in the self-care management process.
RELATED STORY: What exactly is a Patient Centered Medical Home?
With some semblance of Patient Centered Medical Home (PCMH) models emerging in practices across the United States, it’s vitally important to understand the official definition and significant functions and attributes, as prescribed by the Agency for Healthcare Research and Quality (AHRQ).
A PCMH is defined as a medical home that’s not simply a place, but is also a model of the organization of primary care that delivers the core functions of primary healthcare.
The medical home encompasses five functions and attributes:
- Comprehensive care. The PCMH is accountable for meeting the vast majority of each patient’s physical and mental healthcare needs, including prevention and wellness, acute care and chronic care. The team could consist of many players in addition to primary care providers, including advanced practice nurses, physician assistants, nurses, pharmacists, nutritionists, social workers, educators, and care coordinators. Even though some medical home practices may bring together large and diverse teams of care providers to meet the needs of their patients, many others, including smaller practices, will build virtual teams linking themselves and their patients to providers and services in their communities.
- Patient-centered. The PCMH provides primary healthcare that’s relationship-based with an orientation toward the whole person. Partnering with patients and their families requires understanding and respecting each patient’s unique needs, cultures, values, and preferences. The medical home practice actively supports patients in learning to manage and organize their own care at the level the patient chooses. Recognizing that patients and families are core members of the care team, medical home practices ensure that they’re fully informed partners in establishing care plans.
- Coordinated care. The PCMH coordinates care across the spectrum of the broader healthcare system, including specialty care, hospitals, home healthcare, and community services and support. Such coordination is particularly critical during transitions between sites of care, such as when patients are being discharged from the hospital. Medical home practices also excel at building clear and open communication among patients and families, the medical home, and members of the broader care team.
- Accessible services. The PCMH delivers accessible services with shorter waiting times for urgent needs, enhanced in-person hours, around-the-clock telephone or electronic access to a member of the care team, and alternative methods of communication, including email. The medical home practice is responsive to patients’ preferences regarding access.
- Quality and safety. The PCMH demonstrates a commitment to quality and quality improvement by ongoing engagement in activities such as using evidence-based medicine and clinical decision support tools to guide shared decision-making with patients and families, engaging in performance measurement and improvement, measuring and responding to patient experiences/satisfaction, and practicing population health management. Sharing robust quality and safety data and improvement activities publicly is also an important marker of a system-level commitment to quality.
SOURCE: Agency for Healthcare Research and Quality.