Nearly half a million patients in New York’s Hudson Valley can now call their primary care physician offices patient-centered medical homes, thanks to a Taconic Health Information Network and Community (THINC) project that garnered participation from six health plans to improve the quality of care in the region.
The health plans–Aetna, CDPHP, Hudson Health Plan, MVP Health Care, UnitedHealthcare and Empire BlueCross Blue Shield–represent some 65 percent of the commercial insurance market in the Hudson Valley and 43% percent of Medicaid managed care. Setting aside competition in favor of cooperation with THINC, the health plans paid $1.5 million this year to 236 primary care physicians in 11 practices that achieved patient-centered medical home (PCMH) recognition from the National Committee for Quality Assurance (NCQA), which served as an objective measure of medical home-ness. The incentives were paid to providers for transformation to a PCMH and for the enhanced, more robust services patients receive in a medical home.
The PCMH transformation project was managed over a one-year period by THINC, the not-for-profit organization that convenes providers, payers, employers, public health agencies, quality organizations, consumers and local leaders to improve the quality, safety and efficiency of health care for the community. The work was managed in collaboration with Taconic IPA.
“This success of this project means we’ve reached critical mass for the medical home in the Hudson Valley,” said Susan Stuard, THINC’s executive director. “A majority of the commercial and public program insurance plans serving the Hudson Valley worked together to support the foundation of primary care–bring better preventive care, improved chronic condition care, and better access to coordinated care. Ultimately, this project shows that those caring for the people of the Hudson Valley can move beyond competition to enhance quality.”
The PCMH is an emerging model of care in which patients select a primary care practice to be their “medical home.” Work flow at practices is redesigned to emphasize a team-based approach to care. Core components include better access to care through open scheduling and use of electronic health communication tools, care coordination among providers, a focus on preventive care and the use of health information technology tools such as electronic health records and electronic prescribing.
The Joint Principles of the Medical Home, adopted in 2007 by the nation’s leading primary care physician organizations, assert that payment to physicians should recognize the added value provided to patients in a medical home. THINC’s PCMH transformation project ideally brought together physician practices committed to practice transformation and the payers interested in seeing the promise of the medical home fulfilled–improved quality, better patient satisfaction and controlled cost.
The large-scale, multi-payer participation in the project means the benefits of the medical home extend to patients in a PCMH-recognized practice regardless of whether they have a certain type of insurance. PCMH practice transformation positively benefits all the patients served by a practice. Adoption of the medical home model was shown in a national demonstration project to improve measures of quality of care by 8.3 to 9.1 percent and measures of clinical preventive and chronic care services by 5 percent. Outcomes from independent demonstration projects across the country have produced reductions in emergency room visits of as high as 39 percent because of better care for chronic conditions, and significant cost savings.
“The process of becoming a medical home transforms the practice so it can fully utilize the tools of an electronic medical record and align the goals of the practice with the patients to improve the quality of care that the patient receives,” said Mark Foster, MD, chairman of THINC’s board and lead physician of Hudson Valley Primary Care, a participating PCMH practice. “Some of this is obtained by improved care coordination, access and more complete care. This enhanced value for patients and insurers will allow for lower medical costs in the long term as patients are receiving more preventative services on time. This project would not have been successful without the participation of multiple health plans and the assistance from THINC and Taconic IPA.”
Following on the success of its medical home incentive program, THINC, in partnership with Taconic IPA and supported by technical expertise from Geisinger Health System, seeks to bring a model of embedded care management within NCQA Level 3 patient-centered medical homes to achieve gains in efficiency and quality. Geisinger’s ProvenHealth Navigator program will be tailored to meet the specific needs of the Hudson Valley. The program will start with a small pilot at several sites with the ultimate goal of rolling out to medical home recognized primary care providers across the community. THINC believes this program will generate significant improvements in cost and quality of care for high-risk patients and will carry with it national importance in testing the applicability of such a model outside of an integrated health system.
Along with the promise of incentive payment once NCQA recognition was achieved, the health plans provided data which will be used to evaluate the project’s outcomes, part of a five-year commitment from the plans to help practices delivery enhanced care.
“The project evaluation will go beyond what the national demonstration project was able to measure, giving us information about physician satisfaction, patient satisfaction, and improvements in quality of care, which we can report in 2011,” Stuard said. “For the first time, the data set will allow us to benchmark this quality data and then look at those issues over time.” THINC partners with researchers at Weill Cornell Medical College to evaluate the outcomes of its programs.
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About the Taconic Health Information Network and Community (THINC)
THINC is dedicated to improving the quality, safety and efficiency of health care for the benefit of the people of the Hudson Valley region of New York. The primary purpose of THINC is to advance the use of health IT through the sponsorship of a secure health information exchange network, the adoption and use of interoperable EHRs and the implementation of population health improvement activities, including public health surveillance and reporting, pay for performance, patient centered medical home practice transformation, care coordination activities, public reporting and other quality improvement initiatives. For more information, go to www.THINC.org. THINC is part of the Hudson Valley Initiative, an effort to revolutionize health care delivery through a shared vision to improve the quality, safety and efficiency of health care in the community. To learn more, go to http://www.hudsonvalleyinitiative.com.