Managing Chronic Illness: Physician Practices Increased The Use Of Care Management And Medical Home Processes

Wiley, James; Rittenhouse, Diane R.; Shortell, Stephen M.; Casalino, Lawrence P.; Ramsay, Patricia P.; Bibi, Salma; Ryan, Andrew M.; Copeland, Kennon R.; Alexander, Jeffrey A.

doi:10.1377/hlthaff.2014.0404

Cited by 56 publications

(73 citation statements)

References 31 publications

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“…This finding is consistent with results of previous studies in physician organizations, 10,11,16 yet novel in its specific focus on HCs nationwide. We asked HCs whether the clinic or individual providers could receive financial incentives for achieving goals such as high patient satisfaction and certain clinical care targets.…”

Section: Discussionsupporting

confidence: 92%

“…[5][6][7][8] It is important to identify potential ways to increase the capability of HCs to serve as PCMHs, and specifically to identify key characteristics associated with PCMH capability in HCs. Previous studies have examined similar questions in a variety of settings using different outcomes, including: medical home processes, [9][10][11] capacity, 12,13 and infrastructure, 14,15 care management processes, 16 structural capabilities, 17,18 program implementation progress index, 19 and the percentage point or the level of recognition achieved on the National Committee on Quality Assurance (NCQA) PCMH standards. [20][21][22][23] These studies have identified a few characteristics associated with medical home capability, such as practice size, type, and ownership, external incentives, organizational relationships, health information technology (HIT), and patient and neighborhood demographics and socioeconomic characteristics.…”

mentioning

confidence: 99%

“…[24][25][26] However, these studies are limited in their ability to identify specific characteristics associated with PCMH capability in HCs and the magnitude of their impact. Most studies have focused on non-HCspecific settings such as physician organizations, family medicine practices, and Veterans Health Administration clinics, [9][10][11][12][13][14][15][16][17][18][19][20][21][22] which differ from HCs in financing, patient populations, payer mix, disease burden, and surrounding communities. To our knowledge, only one study has been conducted in HCs, among 50 safety net clinics in New Orleans.…”

mentioning

confidence: 99%

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Characteristics Associated with Patient-Centered Medical Home Capability in Health Centers: A Cross-Sectional Analysis

et al. 2016

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Section: Discussionsupporting

confidence: 92%

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confidence: 99%

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confidence: 99%

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Characteristics Associated with Patient-Centered Medical Home Capability in Health Centers: A Cross-Sectional Analysis

et al. 2016

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“…12,[14][15][16] Characteristics such as the number of providers in the practice have been associated with adoption of systems and HIT in support of cancer screening. 17 However, adoption of HIT systems at the practice level does not ensure that physicians will make use of them. As one study reports, one in five physicians did not use prompts or reminders even when the technology was available in their practice.…”

Section: Introductionmentioning

confidence: 99%

Inadequate Systems to Support Breast and Cervical Cancer Screening in Primary Care Practice

et al. 2016

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BACKGROUND: Despite substantial resources devoted to cancer screening nationally, the availability of clinical practice-based systems to support screening guidelines is not known. OBJECTIVE: To characterize the prevalence and correlates of practice-based systems to support breast and cervical cancer screening, with a focus on the patientcentered medical home (PCMH). DESIGN: Web and mail survey of primary care providers conducted in 2014. The survey assessed provider (gender, training) and facility (size, specialty training, physician report of National Committee for Quality Assurance (NCQA) PCMH recognition, and practice affiliation) characteristics. A hierarchical multivariate analysis clustered by clinical practice was conducted to evaluate characteristics associated with the adoption of practice-based systems and technology to support guideline-adherent screening. PARTICIPANTS: Primary care physicians in family medicine, general internal medicine, and obstetrics and gynecology, and nurse practitioners or physician assistants from four clinical care networks affiliated with PROSPR (Population-based Research Optimizing Screening through Personalized Regimens) consortium research centers. MAIN MEASURES: The prevalence of routine breast cancer risk assessment, electronic health record (EHR) decision support, comparative performance reports, and panel reports of patients due for routine screening and follow-up. KEY RESULTS: There were 385 participants (57.6 % of eligible). Forty-seven percent (47.0 %) of providers reported NCQA recognition as a PCMH. Less than half reported EHR decision support for breast (48.8 %) or cervical cancer (46.2 %) screening. A minority received comparative performance reports for breast (26.2 %) or cervical (19.7 %) cancer screening, automated reports of patients overdue for breast (18.7 %) or cervical (16.4 %) cancer screening, or follow-up of abnormal breast (18.1 %) or cervical (17.6 %) cancer screening tests. In multivariate analysis, reported NCQA recognition as a PCMH was associated with greater use of comparative performance reports of guidelineadherent breast (OR 3.23,

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“…We identified these groups using 2 prior national surveys of medical groups, 14,15 the membership list of the American Medical Group Association, the list of first-year participants in the Medicare Pioneer and Shared Savings ACO programs, and groups known to our team and knowledgeable experts whom we consulted. We then selected 7 groups chosen to represent a variety of sizes and geographic areas; 5 agreed to participate.…”

Section: Methodsmentioning

confidence: 99%

Large Independent Primary Care Medical Groups

Casalino

Chen

Staub³

et al. 2016

The Annals of Family Medicine

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PURPOSEIn the turbulent US health care environment, many primary care physicians seek hospital employment. Large physician-owned primary care groups are an alternative, but few physicians or policy makers realize that such groups exist. We wanted to describe these groups, their advantages, and their challenges. METHODSWe identified 21 groups and studied 5 that varied in size and location. We conducted interviews with group leaders, surveyed randomly selected group physicians, and interviewed external observers-leaders of a health plan, hospital, and specialty medical group that shared patients with the group. We triangulated responses from group leaders, group physicians, and external observers to identify key themes. RESULTSThe groups' physicians work in small practices, with the group providing economies of scale necessary to develop laboratory and imaging services, health information technology, and quality improvement infrastructure. The groups differ in their size and the extent to which they engage in value-based contracting, though all are moving to increase the amount of financial risk they take for their quality and cost performance. Unlike hospital-employed and multispecialty groups, independent primary care groups can aim to reduce health care costs without conflicting incentives to fill hospital beds and keep specialist incomes high. Each group was positively regarded by external observers. The groups are under pressure, however, to sell to organizations that can provide capital for additional infrastructure to engage in value-based contracting, as well as provide substantial income to physicians from the sale.CONCLUSIONS Large, independent primary care groups have the potential to make primary care attractive to physicians and to improve patient care by combining human scale advantages of physician autonomy and the small practice setting with resources that are important to succeed in value-based contracting.

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Managing Chronic Illness: Physician Practices Increased The Use Of Care Management And Medical Home Processes

Cited by 56 publications

References 31 publications

Characteristics Associated with Patient-Centered Medical Home Capability in Health Centers: A Cross-Sectional Analysis

Characteristics Associated with Patient-Centered Medical Home Capability in Health Centers: A Cross-Sectional Analysis

Inadequate Systems to Support Breast and Cervical Cancer Screening in Primary Care Practice

Large Independent Primary Care Medical Groups

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