Patient-centered medical homes: the real value of a new payer model

By Dodge Communications on February 23rd, 2012

Over the last week at the annual HIMSS Conference I had the opportunity to participate in conversations about what medical organizations are doing to reduce healthcare costs and improve care. Of all these conversations one panel session on patient-centered medical homes (PCMH) stood out to me as showing concrete ways to achieve these goals.The session brought together four stakeholders (a patient advocate, a care coordinator, a primary care physician (PCP) and a payer) to showcase how a well-planned PCMH can significantly improve patient health and reduce costs. Each panelist detailed how the new model impacted them and why they decided to move forward with this plan.To start the panel, the patient advocate, Helen, recounted how in 2007 her already busy family suddenly became the sole care givers to both of her elderly parents, who were battling multiple chronic diseases. Over the next few years, the family made numerous trips to the hospitals because of these diseases, which became financially and emotionally taxing.  A few years into this routine, Helen received a phone call from her parents' PCP explaining that the practice would now operate as a PCMH. This new model meant that Helen’s parents, who were considered high risk patients, would be monitored by a care coordinator to ensure that they received the necessary treatment to improve their health.

Over the course of the panel discussion, the care coordinator and the PCP explained that reducing costs and improving care drove them to the new PCMH model. The basis of the model was that if diseases are treated proactively, the cost and frequency of care would be less. The care coordinator was crucial to this model because she monitors high-risk patients to ensure patients follow treatment plans accurately and that the desired results were being seen. Since the practice moved to this model two years ago, they have seen patients – including Helen’s parents – become healthier and overall, costs have decreased.Finally, it was revealed that this new model was funded by the payer – specifically the payer provided the care coordinator. The theory was that the care coordinator could ensure proactive management of care, so the sickest patients who account for the majority of healthcare costs would become healthier. From the very beginning, the insurance company realized cost savings and is now working to implement this same system in 100 practices around the nation by the end of the year.This panel proved that costs can be reduced and quality can be improved just one practice and payer at a time. Over the next few years, it is anticipated that the number of practices participating in the PCMH model will grow and the quality of healthcare will improve. All leading to healthier patients and cost savings.