First randomized, controlled trial of PCMH conducted in general adult population
NEW YORK, NY (September 10, 2012) — Achieving Patient-Centered Medical Home (PCMH) status has become a priority for primary care practices to accomplish improved patient outcomes while reducing costs. However, attaining PCMH designation is especially challenging for smaller practices.
EmblemHealth, a New York-based health insurance company, and researchers at the University of Connecticut (UConn) have found that smaller primary care practices — with 10 or less physicians — can make a rapid and sustained transition to a Patient-Centered Medical Home when provided external support, including practice redesign, care management and payment reform. Without such supports, change is slow and limited in scope. The study's findings are published in the September 2012 Journal of General Internal Medicine.
Led by Judith Fifield, Ph.D. at UConn, and supported by The Commonwealth Fund, "A Randomized, Controlled Trial of Implementing the Patient-Centered Medical Home Model in Solo and Small Practices," addressed two primary questions:
- Can independent practices of varying sizes transition to PCMH?
- What components of the PCMH model are more or less amenable to change, with or without external support?
According to the study's authors, the majority of primary care practices in the US are of small or medium size, and not part of an integrated health system. There is growing concern about the capacity of small practices to make the PCMH transition.
The study recruited 18 practices for the intervention group and 14 practices for the control group. EmblemHealth contracted with consultants to advise the intervention physician group on ways to redesign their practices. EmblemHealth also contracted with nurse care managers who were embedded in the 18 intervention group practices. They provided education about developing patient care plans and coordinating care with other providers.
The 18-month study showed that small practices receiving EmblemHealth support improved significantly on eight of the nine National Committee for Quality Assurance (NCQA) standards for Medical Homes.
- Only 44 percent of the control physician practices accrued any points toward NCQA standards, whereas 100 percent of the intervention practices accrued PCMH points.
- After 18-months, 80 percent of the intervention group practices achieved level 3 NCQA Patient-Centered Medical Home recognition, the highest designation, an additional 5 percent achieved level 2 status, and 10 percent were at level 1.
- Intervention practices were 27 times more likely than the control group to improve their NCQA PCMH status by one level.
The intervention group received financial support from EmblemHealth that included incentive payments as they achieved benchmarks in the transition to PCMH. The 14 control group practices were compensated for providing data during the study.
"EmblemHealth's leadership in designing a rigorous study of a PCMH transition model offers unique guidance for solo and small primary care offices," Dr. Fifield said. "We look forward to releasing additional insights into the quality and efficiency benefits of the transition soon."
In addition to lead author Dr. Judith Fifield, the study's authors from the University of Connecticut Health Center are Deborah Dauser Forrest, Ph.D., Melanie Martin-Peele, MA, Joseph A. Burleson, Ph.D., Jeanette Goyzueta, MPH, Marco Fujimoto, and from EmblemHealth, William Gillespie, MD, Chief Medical Officer.
"The University of Connecticut Health Center, with the support of The Commonwealth Fund, is to be commended for this rigorous evaluation of EmblemHealth's work," Dr. Gillespie said. "This study will help shape the discussion of how small practices throughout the nation can make the transition to Patient-Centered Medical Homes."
The Patient-Centered Medical Home model is based upon the principles advanced by the four primary care physician groups — the American Academy of Family Physicians (AAFP), the American Academy of Pediatrics (AAP), the American College of Physicians (ACP), and the American Osteopathic Association (AOA). According to the NCQA, which certifies medical practices as PCMHs, this increasingly popular delivery system innovation will lead to safer, higher quality care, more empowered patients and a renewal of the patient-provider relationship.
EmblemHealth, Inc., through its companies Group Health Incorporated (GHI) and HIP Health Plan of New York (HIP), provides quality health care coverage and administrative services to approximately 2.8 million people. Groups and individuals can choose from a variety of PPO, EPO and HMO plans, as well as coverage for prescription drugs and dental and vision care. EmblemHealth offers a choice of networks, including quality doctors and other health care professionals throughout the region, leading acute care hospitals across the tristate area, and physicians and hospitals across all 50 states.
The University of Connecticut Health Center includes the schools of medicine and dental medicine, the UConn Medical Group, University Dentists, and John Dempsey Hospital. Home to Bioscience Connecticut, the Health Center pursues a mission of providing outstanding health care education in an environment of exemplary patient care, research and public service. More information about the UConn Health Center is available at www.uchc.edu.
The Commonwealth Fund is a private foundation supporting independent research on health policy reform and a high performance health system.