The answers to the conundrum posed in the last blog post, how to coordinate care for a patient afflicted with several different conditions, do seem to be out there. When something appears insoluble, I always try to look for the success stories on the innovative edge which can lead the way for everyone else. I did a lot of reading about patient-centered medical homes and integrated healthcare delivery systems. The philosophy behind these ostensibly closed loop, tightly coordinated systems seems wonderful. Who wouldn’t want to go to a community of doctors working hand-in-hand with each other with everyone singing from the same hymnal? And I saw some impressive data demonstrating the efficacy of coordinated medicine.
So why am I not seeing this wondrous, magical world of coordination in the lives of myself, relatives, and friends? Are we poor, benighted people in the I-95 corridor in the northeast US living in a backwards area from a healthcare delivery perspective? Surely, we have some of the best medical schools in the country if not the world – Columbia, Mt. Sinai, Penn, etc. So where are our medical homes? Are they right under our noses and I’m missing them? Penn Medicine, which owns the hospital right across the street from me, has a centralized patient portal and I’m sure a common platform for sharing patient records. IT innovations are great, however, but they’re merely icing on a poorly baked cake if doctors are not talking to each other to develop well thought out, holistic treatment plans. Please, dear reader, let me know if there’s a well-integrated group practice or health system that you’ve encountered in New Jersey or anywhere else in the US that goes beyond marketing hype and actually delivers silo-free care.
Patient-Centered Medical Homes to the rescue?
Let’s start our search for coordinated care in Michigan. Michigan appears to be a hotbed for patient-centered medical homes. First, what is a PCMH? According to the Patient-Centered Medical Home website, “The primary care medical home coordinates care across all elements of the broader health care system, including specialty care, hospitals, home health care, and community services and supports.”
Reason #1 that Michigan’s a PCMH hotbed is that the state’s largest insurer, Blue Cross Blue Shield of Michigan is solidly behind the PCMH concept. According to BCBSM’s website, “As of March 2019, BCBSM designated over 1,700 physician practices — representing nearly 4,700 primary care physicians — as Patient-Centered Medical Homes. Our PCMH designated practices are in 80 of Michigan’s 83 counties.” If I were a BCBSM member, I could quickly hop on their website and find a doctor who belongs to a patent-centered medical home.
PCMH-designated primary care practices in Michigan seem to deliver better care than non-PCMH practices according to Blue Cross’s website:
► Data from 2018 shows PCMH-designated practices had a 27% lower rate of adult hospital admissions than non-PCMH ones for common conditions that respond to office-based care.
► PCMH practices also had a 16% lower rate of adult ER visits.
► PCMH practices had a 26% lower rate of pediatric ER visits for common chronic and acute conditions, such as asthma.
The skeptic in me says that maybe PCMH practices tend to be in areas with lower incidences of these things. Or the practices that get a PCHM designation are already better to start with. However, the esteemed National Committee for Quality Assurance (NCQA) backs up Michigan Blue Cross’s claims of improved outcomes and I’m inclined to believe NCQA.
A Garden State it’s not when it comes to PCMHs
And then we get to New Jersey, where I live. My insurer is Horizon Blue Cross Blue Shield. Their website says nothing about patient-centered medical homes. Later, I learn that there are a whopping total of 19 PCMHs in a state with 8.9MM people and they’re all in economically disadvantaged areas.
So why are the denizens of my fair state being deprived of the benefits a medical home can provide? The answer, like the answers to so many other questions, lies with money. A report by the United Hospital Fund on PCMHs in New York State offers this sobering reason: “Operating as a medical home requires new functions and staff that increase operating costs, which are not covered by traditional fee-for-service payments or by most emerging value-based payment arrangements. Few payers other than Medicaid support medical homes. This leaves many practices—particularly small independent primary care practices—unable to afford to switch to the PCMH model.”
What can other insurers learn from Blue Cross Blue Shield of Michigan’s experience? BCBSM appears to be doubling down on its commitment to patient-centered medical homes. Here’s hoping that insurers in other parts of the country are willing to make the same short-term sacrifice to their bottom lines that their Michigan brethren did. It just might lead to significant payoffs for everybody.
