The Role of Managed Care in the Medical Home

Providing a Lifeline for Primary Care Practices

The skyrocketing rise of healthcare costs is an ongoing dilemma – one that is gaining increased attention from lawmakers, employers, payers, physicians and consumers as it threatens the stability of the U.S. economy. One of the reasons attributed to the high cost of care is that the primary care system is not meeting the needs of consumers.

Today, it is estimated that nearly one in five Americans, or 60 million individuals, lack adequate access to primary care due to a shortage of primary care physicians in their communities. All stakeholders agree the systems needs an overhaul to contain costs, improve the delivery of care and make changes to the reimbursement system to reward quality vs. quantity.

One of the models gaining attention as a possible solution is the implementation of the Patient Centered Health Care Home (PCHCH). The model provides a positive way for payers and providers to work together to meet the needs of members by increasing access to services, supporting care coordination across the continuum, improving patient accountability through information and active decision-making, and driving efficiency and effectiveness. The model also provides the pathway to change the reimbursement system to one that bestows incentives to providers who deliver care in a more coordinated and efficient manner.

Our next webinar will bring together a team from the Health Plan of Michigan to discuss the success they have seen in improving care for their members as well as raising satisfaction levels for primary care physician practices as they have transitioned to the patient-centered health care home.

By attending this training session you will be able to: Describe the value the payer and provider gain through the PCHCH. Learn about the quality metrics providers and payers can generate that demonstrate improvement in member healthcare status. Explain how incentives are improving providers’ morale and strengthening relationships with payers. Discuss the improvements in preventive care as well as improvements in care coordination for patients with chronic medical conditions as a result of the care provided through the PCHCH.

About the Webinar

Primary care is critical to promoting health, improving care and reducing overall system costs, but it has been historically underfunded and undervalued in the U.S. According to the American College of Physicians, primary care practice is on the verge of collapse. This is because very few young physicians are choosing primary care and many of those already in practice are leaving due to heavy workloads, increasing demands and poor reimbursement rates. In an effort to revive primary care practice, health plans are investing in primary care practices through implementation of the medical home. Plans are supporting practices through IT technical support, practice transformation, care coordination, clinical guidelines and enhanced payment.

According to URAC, the accreditation organization that has developed the Patient Centered Health Care Home Practice Achievement Certification Program, the Patient Centered Health Care Home is defined as a quality-driven, interdisciplinary clinician-led team approach to delivering and coordinating care that puts patients, family members, and personal caregivers at the center of all decisions concerning the patient’s health and wellness. A PCHCH provides comprehensive and individualized access to physical health, behavioral health, and supportive community and social services, ensuring patients receive the right care in the right setting at the right time.

The Patient Centered Health Care Home also:

• Utilizes population-based tools to support and monitor wellness and care goals for each patient, aimed at preventing illness and improving individual well-being, clinical outcomes and quality of life.
• Empowers patients to be active participants in their care, through patient-friendly education and informed shared decision-making that is based on cooperation, trust, and respect for each individual’s health care knowledge and health literacy, values, beliefs, and cultural background.
• Is accountable for coordinating, providing, and monitoring a patient’s needs, including prevention, wellness, medical and behavioral health treatment, care transitions, and social and community services where appropriate through the creation of an appropriate individual plan of care. Optimizes value for patients, payers, and society at large, driven by a commitment to care excellence and customer service. Provides a rewarding place to work, offering a high level of job training and satisfaction for all members of the team and allowing team members to optimize their training and experience.

To learn how health plans and primary care providers are workings together to enhance the patient experience and improve the delivery of care gather your team on December 13, 2011, from 2:00-3:30 p.m. (ET) to participate in a live webinar where our faculty will share their experience and outcomes in this promising model.

Program Objectives:

• Describe the value the payer and provider gain through implementation of the Patient Centered Health Care Home.
• Learn about the quality metrics providers and payers can generate to demonstrate improvement in member healthcare status.
• Explain how incentives are improving provider’s morale and strengthening relationships with payers.
• Discuss how the through a team effort data is produced to demonstrate improved outcomes in preventative care as well as in care for patients with chronic medical conditions as a result of the care provided through the PCHCH.

Our Webinar Will Answer These Questions:

• What is the benefit to the health plan for investing in the transition of their primary care practices to the patient centered medical home?
• What value does the primary care physician gain from the patient centered healthcare home?
• What outcomes can both sides expect to achieve as a result of the collaboration?
• What incentives are awarded to the practices who implement the patient centered healthcare home?
• What are the metrics that need to be achieved to qualify for the incentives?
• How have patients, providers and payer satisfaction levels changed with the implementation of the patient centered healthcare home.

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