How Geisinger’s Advanced Medical Home Model Argues The Case For Rapid-Cycle Innovation

The Patient-Centered Medical Home (PCMH) is a leading model of primary care reform, a critical element of which is payment reform for primary care services. With the passage of the Affordable Care Act, the Accountable Care Organization (ACO) has emerged as a model of delivery system reform, and while there is theoretical alignment between the PCMH and ACOs, the discussion of physician payment within each model has remained distinct. Here we compare payment for medical homes with that for accountable care organizations, consider opportunities for integration, and discuss implications for policy makers and payers considering ACO models. The PCMH and ACO are complementary approaches to reformed care delivery: the PCMH ultimately requires strong integration with specialists and hospitals as seen under ACOs, and ACOs likely will require a high functioning primary care system as embodied by the PCMH. Aligning payment incentives within the ACO will be critical to achieving this integration and enhancing the care coordination role of primary care in these settings.

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“…17,18 Thus, the primary care practice plays the central role in the delivery of high value care, and benefits directly from additional payments.…”

Section: Unit Of Organizationmentioning

confidence: 99%

Structuring Payment to Medical Homes After the Affordable Care Act

et al. 2014

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“…14,15 Others have looked at fulfilling this role in the outpatient setting. 16,17 A recent systematic review of primary care clinic-based postdischarge phone calls showed no impact on readmission rates, but only 3 studies were included. 18 Health plan-initiated telephone calls to plan members after hospital discharge reported a 22% reduction in readmissions.…”

Section: After Hospital Dischargementioning

confidence: 99%

A primary care physician's ideal transitions of care—where's the evidence?

Tang

2013

Journal of Hospital Medicine

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Reducing hospital readmissions is a national healthcare priority. Most of the interventions to reduce hospital readmission have been concentrated in the inpatient setting. However, there is increasing attention placed on the role of primary care physicians (PCPs) in improving the transition from hospital to home. In this article, a primary care physician's perspective of how inpatient and outpatient providers can partner to create the ideal care transition is described. Seven steps that occur during the hospitalization are highlighted: communicate with the PCP on admission, involve the PCP early regarding discharge planning, notify the PCP on hospital discharge, complete the discharge summary at time of discharge, schedule follow‐up appointments by discharge, ensure prescriptions are available at the patient's pharmacy, and educate the patient about self‐management. Another 7 are described as the role of the PCP and clinic staff: call the patient within 72 hours of discharge, ensure follow‐up appointments with the PCP, coordinate care, repeat above until medically stable, create access for patients with new symptoms, track readmission rates, and track and review frequently admitted patients. Insights are offered on how the changing financial landscape can help support elements of this idealized transition‐of‐care program. Journal of Hospital Medicine 2013;8:472–477. © 2013 Society of Hospital Medicine

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“…[8][9][10] In fact, the complexity underlying achievement of medical homes may be out of reach of many PC practices, 11 especially those without electronic health records, data systems, access to care managers, structured practice facilitation, and other key elements. [12][13][14][15] Findings from widely publicized medical home efforts, such as those at Geisinger, Intermountain and Group Health, suggest early provider burnout and significant challenges in operationalizing the tenets of PCMH in diverse settings, yet have nonetheless managed to accomplish important process and outcome changes. 16 We address these questions in the Veterans Health Administration (VA), the largest integrated healthcare delivery system in the U.S., with hospital-based and freestanding PC clinics spanning all 50 U.S. states and several territories.…”

Section: Introductionmentioning

confidence: 99%