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Patient Centered Medical Home

What is the Patient Centered Medical Home Pilot?

The Patient Centered Medical Home (PCMH) is not a place but an approach to providing continuous, comprehensive, coordinated care, with a partnership between patients and their personal healthcare team, as part of an integrated medical neighborhood.

 

 

The Patient Centered Medical Home Pilot includes multiple participants at both the local and national level. The Patient Centered Medical Home (PCMH) is not a place but an approach to providing continuous, comprehensive, coordinated care, with a partnership between patients and their personal healthcare team, as part of an integrated medical neighborhood. MedicalHomeLogo2

 

The Medical Home emphasizes whole person orientation with:

  • coordinated and/or integrated care across all elements of the complex health care system
  • enhanced access to make it easier for patients to contact their personal healthcare team
  • improved quality and safety by promoting prevention, proactively managing chronic illness, engaging patients in their care to attain optimum health, and using electronic systems to support this work

 

To enable practices to make this transformation and build important infrastructure, the PCMH model realigns payment to include standard fee for service, a monthly care management fee and a bonus for meeting or exceeding quality outcomes. This ‘blended’ payment model shifts the focus of care delivery away from episodic care toward more comprehensive, holistic care and incorporates the characteristics associated with both lower costs and better outcomes.

The PCMH model will be tested in sixteen Family Medicine and Internal Medicine practices selected from across the Colorado Front Range as well as practices in Cincinnati, our partner region. Following an initial preparation period, payment for the two-year PCMH Pilot will begin May 2009, once practices have met specific requirements to achieve at least a Level 1 NCQA Medical Home designation. Practices will receive modified payments for up to 30,000 patients covered by the participating health plans, including Anthem-Wellpoint, United Healthcare, Humana, Aetna, CIGNA, Colorado Medicaid and CoverColorado.

The Colorado Clinical Guidelines Collaborative (CCGC) will serve as the Convening Organization and provide technical assistance for the PCMH Pilot practices in Colorado, including in-office coaching, Learning Communities & innovative technology. The pilot will be evaluated by Meredith Rosenthal, PhD from Harvard School of Public Health to determine the effect on quality, cost trends and satisfaction for patients and their healthcare team. Funding for the pilot has been generously provided by The Colorado Trust and The Commonwealth Fund.

The Patient Centered Medical Home is based on years of research that supports the need to bolster and reorganize how primary care is delivered and paid for. By following a patient-centric approach, every segment of the health care system stands to benefit: patients, providers, employers, and payors. This will be a period of discovery to learn what works and what doesn’t – but the most important aspect is taking this important step towards healing our broken healthcare delivery system.