Patient-Centered Medical Homes: Overview, Experience to Date, Success Factors

Thirteen PCMH programs; five started in 2008/2009, others started in 2011 and 2012.
Eight multi-payer: NY, CT, MD, RI, OH, CO, TX, MO 

• Two single-payer in AZ and TX
• Chronic care medical home pilot in MO –partnering with BOEING, MONSANTO, GE, and UNITED
• CMS Comprehensive Primary Care Initiative 

(CPCi) 5 year Demonstration Project in CO, NJ, and OH
A significant and growing level of impact:

• Membership: 250K+ members impacted
• Physician Practices: 250+
• Primary Care Providers: 2000+
• Participating employer groups: 650+ 

Observations:

• Practices need to be ready and willing to change 
• Need clearly defined, engaged physician and administrative leadership
• Structure alone does not drive outcomes
• Processes need to be adopted and sustained to realize clinical and operational efficiency improvements
• Multi-stakeholder pilots provide the economies for sustainable change 

Early Findings:

• Dedicated embedded, care manager and coordination is key to success of overall patient population management 
• Two-way data sharing enables better care management actions
• Performance payments can affect change in behavior
• Practice collaboration is key to leveraging best practices
• This is hard stuff which requires heavy lifting..….if there were easy answers, primary care wouldn’t be in crisis!