PCMH strategies that drive ACOs

Physician leadership, quality measurement and reporting, clinical integration of care coordinators, common care delivery across all patients, chronic disease registries and an integrated delivery network all are key patient-centered medical home (PCMH) strategies that can bolster ACO development, according to Michael Jeremiah, MD, of Roanoke, Va.-based Carilion Clinic.

Jeremiah and Deborah Redmond, from UPMC Health Plan in Pittsburgh, shared their wisdom and experience of moving their medical home models to ACOs during a March 28 webinar hosted by the Washington DC-based Patient-Centered Primary Care Collaborative.

The Carilion Clinic, an eight-hospital system, launched its first PCMH site in 2009 and currently is working to expand that number to 45. The system became an ACO in 2012.

“We really found that the initial work in the past years has helped us understand how we want to approach our efforts as an ACO, and helped our application process to become one,” Jeremiah said. “Our goal is to reduce need for unnecessary utilization. We’ve begun to see good trends and outcomes.”  

Quality metrics showed early successes for its population of 23,473 patients with type 2 diabetes, Jeremiah said. In a two-year retrospective study, diabetic patients at PCMH sites showed improvement in a number of measures, including A1C, LDL, BMI, DBP and SBP, he reported.

However, getting on board with the PCMH took time. He said due to difficulty in integrating the care coordinators into the clinical setting and other factors, turnover for care coordinators reached 56 percent at the beginning. After efforts to establish formal relationships at the sites, adjust compensation and clearly delineate job responsibilities, they experienced no turnover last year.

The upcoming development of an enterprise data warehouse for integration of EMR data and healthcare claims also is driving the ACO transition. “We think that this is going to really enhance our knowledge of where the high risk and chronic disease patients are, where they are receiving care, what the cost of that care is, and the best opportunities to impact that in the right direction” Jeremiah said.

Redmond, VP of clinical affairs at UPMC, weighed in that an effective PCMH links all the components of levels of care.

The UPMC health plan medical home was rolled out in 2008 and now incorporates nearly 150,000 members across 165 sites. “We have a strong partnership with regional hospitals and physicians. That is really the core of where our [PCMH] has come from,” she said.

“With our embedded care managers, they are the primary touch point for surveying the status of the members in those practices, having it drive communication and huddles and coordination of care with the primary care provider in that practice,” Redmond explained. Each care coordinator has access to inpatient data so they can really focus on gaps of care, she said.

UPMC uses an analytics engine and saw results across several metrics, including readmission, emergency department utilization and the generic fill rate. “The focus on quality was an early success factor. It drove stickiness and collaboration at the practice level around a focused activity. It gave more purpose to the practice-based care manager from the very beginning,” she said.  

She also highlighted new reimbursement models and shared savings arrangements in care coordination support that have grown significantly and helped fueled their success. Moreover, she said a payer-provider committee structure has engaged physicians and business leaders in the process.