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The patient-centered medical home (PCMH) is not only a proven pathway to patient satisfaction but also a legitimate stepping stone to an accountable care organization (ACO).

Fifty-two percent of 2012 HIN survey respondents* have established medical home programs for their populations; 59 percent of these are now or soon will be part of an ACO.

To prepare for this eventuality, medical homes are fortifying the model with a framework of IT and infrastructure and indoctrinating doctors in the medical home's dual priorities of care coordination and healthcare quality.

Those are some of the hallmarks of the medical home initiatives profiled in New Models in the Patient-Centered Medical Home: Incentives, Infrastructure and IT to Support Accountable Care.

Beginning with an overview of 2012 PCMH trends, this 57-page special report offers snapshots of thriving medical home initiatives and their particular area of focus:

• Florida Blue's statewide medical home model, and lessons learned from the 2011 rollout that transitioned the payor from a pay for performance emphasis to a medical home model. Barbara Haasis, RN, CCRN, senior clinical lead, quality reward and recognition programs at Florida Blue, describes the transition, provides details on the following areas:
  • The criteria for which physician practices were selected to participate in the program;
  • The shared savings approach through which practices will be reimbursed;
  • The role of a nurse educator in helping the practices transform;
  • Reporting practice results to drive further improvement;
  • Results in total cost of care from physicians originally enrolled in the pay-for-performance program, now in the first quarter of the PCMH.

• A four-pronged approach by Horizon Blue Cross Blue Shield of New Jersey's consumer engagement team to more closely involve consumers and health plan members in its medical home program, first launched in 2008. Jay Driggers, director of consumer experience and engagement at Horizon BCBSNJ, shares how Horizon approaches engagement, including:
  • Seven key consumer engagement objectives;
  • The impact of stand-alone pilots on consumer engagement, from iPhone apps to telemonitoring;
  • A best practice approach to driving awareness and education of the patient-centered medical home to build a connection between a patient and a practice, including the use of a patient touchpoint map to increase a patient's 'stickiness' to a practice;
  • Results from Horizon's patient engagement approach; and
  • Using PCMH patient engagement techniques to position for accountable care.

• Perspectives from the Hunterdon Healthcare medical home initiative, in which its 24 family practices recently achieved Level III NCQA recognition. Additionally, Hunterdon is collaborating with Aetna in an accountable care organization, has joined Horizon Blue Cross Blue Shield of New Jersey's patient-centered medical home program and has been named to the CMS Comprehensive Primary Care initiative, a payor-provider collaboration to test new primary care reimbursement models.

  In an extended interview, George Roksvaag, MD, chief medical officer of Hunterdon Healthcare, and Geralyn Prosswimmer, MD, FAAP, medical director of primary care services for Hunterdon Healthcare and medical director for Hunterdon Healthcare Partners, talk about the challenges of simultaneous participation in three primary care initiatives.

  They also share details on the following:

  • Organizational motivation for pursuing medical home recognition;
  • The challenges of physician engagement;
  • Reengineered staffing and workflows that are transforming care coordination;
  • Patient response to the PCMH;
  • Differences they've observed thus far between the patient-centered medical home and the ACO model.

  Hunterdon Healthcare was a respondent to HIN's 2012 Survey on the Patient-Centered Medical Home Model.

Table of Contents

• Introduction: 2012 Benchmarks in the Patient-Centered Medical Home
  • Survey Highlights
  • Key Findings
  • About the Survey
  • Respondent Demographics
• PCMH Lessons from a Statewide Rollout: The Florida Blue Experience
  • Challenges and Lessons Learned
  • Rollout of the PCMH
  • Program Rewards and Incentives
  • Program Goals and Next Steps
  • Eligibility Requirements
  • Physician Scorecards
  • Addressing Small Physician Groups
  • Tools to Promote Evidence-Based Care
• Patient Engagement in the Patient-Centered Medical Home: A Continuum Approach
  • Horizon Healthcare Innovations
  • Redefining the Term 'Consumer'
  • Leveraging Communications and Education
  • 7 Consumer Engagement Objectives
  • Research into the Consumer Mindset
  • Piloting Technology
  • Incentives and Behavioral Economics
  • 5 Core Elements of the PCMH Model
  • Collaborations with Practice Partners
  • Challenges and Lessons Learned
• The Hunterdon Healthcare Medical Home Experience: Piloting the ACO and Comprehensive Primary Care
  • Program Participation
  • Challenges of NCQA Recognition
  • Integration of Behavioral Health
  • Workflow and Staffing Changes
  • Embedded Case Management
  • Physician Reimbursement Models
  • Comparing the ACO and Medical Home Models
• Q&A: Ask the Experts
  • Physician Incentives
  • Measuring ROI
  • Physician Participation in PCMH
  • Physician Efficiency Metrics
  • Ensuring Patient Engagement
  • Patient Incentive's
  • Scoring Patient Engagement for Physician Evaluation
  • PCMH Effect on Medication Adherence
  • Payor Coordination
  • Program-to-Program Communication
  • Engaging PCP and Specialists
  • Outcomes from Participating Providers
  • Responsibilities of Nurse Educator
  • Per-Member-Per-Month
  • Use of Physician Report Cards
  • Choosing a Patient-Provider
  • Tools to Measure Member Satisfaction
  • Adjusting Incentives Based on Risk
  • Dealing with Uncooperative Patients
  • Fee Schedule Multiplier
  • Incentives for Program Recognition
  • Origin of Horizons Medical Home
  • Horizon Members and Physicians
  • Tools to Assess Patient Engagement
  • Efforts to Engage Physicians
  • Initiating Patient Contact
  • Targets for Technology Pilots
  • Keywords for Patient Awareness and Follow-Up
  • Modalities for Patient Communication
  • Staff Training and Education
  • Typical Medical Home Practice Size
• Glossary
• For More Information
• About the Contributors