CAMP HILL, PA--Highmark Inc. recently announced it would launch a two-year, patient-centered medical home pilot project. The Pennsylvania-based health insurer said 13 physician practices at 29 locations in western and central Pennsylvania and West Virginia will participate in the project, which is expected to begin on June 1 and involve 160 physicians who care for some 45,000 Highmark members.
"The patient-centered medical home (PCMH) concept is one where a practice-based care team led by the primary care physician (PCP) coordinates all the care for the patient," said Robert Nielsen, MD, a primary care physician at Annville Family Practice in Lebanon County, Pa., and participant in the project. "This approach means working with the patients and their families across care settings to support their care decision making and to assist in coordinating the care experience."
Under the pilot, PCP reimbursement will be modified to provide compensation to help fund a practice's transformation to a patient-centered medical home. Fundamental to the model is the implementation of care coordination, patient information transfer and clinical outcomes-based reporting, Highmark officials said.
"We are confident that these practices will improve patient care for Highmark members," said Mary Goessler, MD, medical director of quality management at Highmark. "We believe by significantly improving communications and patient information exchange between primary care physicians, specialists and hospitals, coupled with working more closely with patients in coordinating care and establishing self management goals, we will realize a sustained improvement in care quality and patient outcomes. Over time, our goal is to slow the growth of care costs."
According to Goessler, when a patient is transitioned from one care setting to the next, communication breakdowns can result in medication errors, duplicate tests and services and lack of proper patient follow-up. Through better management and coordination of care, Highmark anticipates fewer hospital readmissions and reduced emergency room visits.
"One of the key elements of the PCMH is that information technology is used appropriately and in a meaningful way to support optimal patient care, patient education and enhanced communication," Goessler said. "This approach will enable physicians to communicate more efficiently with the many caregivers who they speak with on behalf of patients. It will be easier to track records, maintain various registries and check compliance."
Terry McGeeney, CEO for TransforMED, a company that helps providers make the transition to a patient-centered model, says federal government's push via meaningful use incentives has played an important role sowing the seeds for the PCMH.
"There is a lot of synergy between the two," said McGeeney. "It is hard to do good care management without getting your IT infrastructure in place. The MU financial incentives have given practices a reason to get going on this if they had been dragging their feet before."
As a payer, Highmark has taken an active role in promoting the use of electronic health records (EHRs) to improve care quality. In 2008, when Southwest Pennsylvania was named a national demonstration site for the adoption of EHRs by HHS, Highmark earmarked $29 million to help physician practices finance EHRs and electronic prescribing systems. As of late 2010, the company had provided grants to more than 3,100 physicians totaling $19.6 million to help with the deployment of EHRs and e-prescribing systems.
Leveraging these technologies through the PCHM pilot, Highmark executives anticipate this new delivery model will help improve and sustain optimal clinical outcomes and begin to positively impact healthcare cost trends. It will be considered for broader implementation throughout the Highmark primary care network once data from the pilot is assessed, they said.