By Brian Schilling
In late 2009, Purchasing High Performance published an article introducing readers to the patient centered medical home (PCMH)—a new health care delivery model that was being closely watched and generating many questions. Will it save money? Will it improve quality? Will patients like it? Various pilot tests looked promising. Four key medical societies stood behind it. IBM and other employers were strong supporters and a handful of medical groups had become certified as recognized medical home practices by a leading accreditor. The promise was there, but a fundamental question remained: would it work?
Three years later, results from early PCMH demonstrations suggest promising answers. The medical home does appear to improve quality and make care more efficient.1 Furthermore, physicians seem to prefer practicing in medical homes.2 Among employers, support appears to be growing. The Patient-Centered Primary Care Collaborative (PCPCC), a multi-stakeholder coalition with a mission to promote the PCMH model, has a membership of nearly 850 organizations, including dozens of Fortune 100 firms, health plans, unions, utilities, and states. Paul Grundy, M.D., IBM's Global Director for HealthCare Transformation, serves as PCPCC's president and for years has served as the nation's leading PCMH evangelist. Lately, he's been writing letters.
"Last November, I suspect that most major health plans were getting a letter almost every single day from one of their employer clients saying that they wanted their beneficiaries to have access to care through a medical home-type system," said Grundy referring to a coordinated PCMH promotional campaign that involved dozens of other employers. "We wanted to show them that the medical home is something we believe in and that as purchasers of health care we're going to favor plans that adhere to the principles of the medical home model."
Among the other employers participating in efforts to push the medical home model were Fortune 500 firms (e.g., Dow Chemical), 26 states (both as employers and through their Medicaid programs) and, notably, the federal government. The U.S. Office of Personnel Management (OPM), which buys coverage for 8 million federal workers and dependents, was an early supporter of the medical home model and remains a staunch if nonprescriptive advocate.
According to OPM Chief Medical Officer and former Rear Admiral Dr. Christine Hunter, the agency's annual "call letter" (which articulates OPM's expectations of plans serving federal employees) shows the agency places a high priority on integrating care. "On the first page of last year's letter, we listed key initiatives for 2012. Number one on the list directed plans to submit proposals for implementing pilot programs directed at improving and integrating patient care management through redesigned practice models like integrated health care systems or medical homes," said Hunter. This year, Hunter expects the language will be even more direct. "We're strengthening our emphasis on PCMH. We really want to make the point that this is something we care about," she said.
The message has not been lost on health plans. Wellpoint, Aetna, CIGNA, Humana, United, and Blue Cross Blue Shield plans in 39 markets are all working to make medical home-type care available to enrollees. Most have pilot projects in place or are already beyond the pilot stage. That doesn't necessarily mean that every enrollee in every plan will have access to a medical home, but the rollout goals at many plans are ambitious. Blue Cross Blue Shield of Tennessee expects to give 50 percent of its chronically ill members access to a PCMH-focused practice by the end of 2012. At Independence Blue Cross in Pennsylvania, the goal is simply to have as many physicians practicing in PCMH settings as possible. Wellpoint, the nation's largest insurer, is rolling out medical homes in all of its markets.
At integrated health plans like Geisinger Health System and Kaiser Permanente, adoption may even be further along. "Geisinger essentially operates this way already," said Grundy.
For physicians, earning PCMH recognition from a national accreditor is now somewhere between being a valuable way to distinguish oneself in the market and a business imperative. Consequently, the number of practices in the country that have earned PCMH recognition from the National Committee for Quality Assurance (NCQA) has jumped from fewer than 29 in late 2008 to more than 1,500 today. More than 21,000 physicians have earned individual recognition. According to NCQA, some 3,000 practices are expected to earn recognition this year.
IBM's Grundy fully expects that the medical home will continue to play a major role in the long-term evolution of the health care system, but at present he's focused on a more immediate goal. "I can't tell you what the health care system will look like at any point down the road, but for employees of IBM and some other large firms, my expectation is that in three years they'll all have access to care through a medical home," he said.
According to Grundy, the rewards for firms that jump on the PCMH bandwagon early will be tangible. "They're going to get more members," he says, noting that last year IBM made an effort to steer employees to Wellpoint and Anthem—and consequently away from other carriers—based partly on their efforts to establish medical homes in key markets.
"The message I'd like plans to hear," said Grundy, "is that if you can't provide our employees with care that's consistent with the principles of the patient centered medical home in the near future, we're just not going to do business with you."
1 K. Grumbach and P. Grundy, Outcomes of Implementing Patient Centered Medical Home Interventions: A Review of the Evidence from Prospective Evaluation Studies in the United States, (Washington, D.C.: Patient-Centered Primary Care Collaborative, Nov. 16, 2010).
2 L. Flores, The Patient Centered Medical Home: 2011 Status and Needs Study—Reestablishing Primary Care (Englewood, Colo.: Medical Group Management Association–American College of Medical Practice Executives, 2011).
