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Our Decision to Become A PCMH

by Jeff A. Drasnin, MD, FAAP, pediatrics

Regardless of where one stands politically, we physicians need the ability to adapt and grow during this new era of government-enacted health care reform and industry-driven payment reform. One approach that my practice is taking, and one that is gaining traction among other providers, is following the concept of a medical home – more specifically, the model of the Patient-Centered Medical Home (PCMH).

In general, keeping people healthy decreases the utilization of more expensive medical resources, and the PCMH is one very real example of how better care can be cost-effective. Very simply defined, the medical home is designed to provide comprehensive care that is patient centered, coordinated and accessible to deliver higher quality care.

This simple, fundamental concept has largely been ignored until recent years. The American health care system has long been the most expensive in the world, but has it been the best? If we assume that the best health care can lead to living longer, then the best system should have patients who live the longest, right?

Well, according to a 2012 report from the Central Intelligence Agency, the United States ranks #51 in life expectancy. There is a growing body of data supporting the theory that spending a little more on the front end can create real value later. Have any primary care providers ever wondered why you’re reimbursed better for well care than acute visits? Or why wellness visits are generally covered at 100% by most high-deductible plans? This is where insurance companies and the government actually “get it,” recognizing that a healthy person is cheaper to care for than an unhealthy one.

Our best course for the future is not to invent the next hypoglycemic medication to treat Type 2 diabetes; it’s to promote healthy eating and exercise to decrease the likelihood that a patient will ever develop Type 2 diabetes in the first place.

For primary care providers, now is the time to get on board with this line of thinking and practice, or risk missing the bus.

Becoming a PCMH
In its simplest form, attaining PCMH certification requires data gathering, and then using the data to coordinate care. In our practice, we have begun the journey to certification, and our ability to report on and manage our data has been made easier by our athenahealth partners. By relying on services that use the right technology to accelerate PCMH progress, we are more than 50% of the way toward achieving certification.

How can technology improve care? Here’s an example: We use our EHR to run reports on the status of our asthmatic population, and then use our communication services and patient portal to reach out and make sure those patients come in for regular follow-ups and flu vaccines. We also use an interface with local hospitals to identify our patients who have been seen in the Emergency Department, and call them to hopefully help prevent the need for that level of service in the future.

We have found that our families have been very receptive to our aggressive use of technology to seek them out and push them toward healthier choices. Many families are surprised when we call because it’s not usual. Well, it is for our office. And it’s just the beginning.

We are starting to enact policies that change how we practice medicine. Health care reform is here and the reimbursement model is changing from the standard “fee for service” to a more holistic “coordination of care” and “disease management.” We must prove our value in this new reality, especially to our patients. The certification as a medical home is a start. Practicing in a way that embraces its ideals is the way to go further.

To learn more about the PCMH accelerator program, visit here.

Dr. Drasnin is an athenahealth client specializing in pediatric medicine at ESD Pediatric Group in Cincinnati, Ohio.

Dr. Drasnin is an athenahealth client specializing in pediatric medicine at ESD Pediatric Group in Cincinnati, Ohio.

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