Rhode Island leads the nation in the number of physicians per capita who are practicing in patient-centered medical homes, which is expected to be the norm for the future delivery of health care services.
For businesses that are looking for ways to lower health care costs, patient-centered medical home are touted as a way to improve care for their employees, slow the increases in their costs of providing coverage and reduce unnecessary absenteeism.
Dr. Deidre Gifford, director of the Rhode Island Chronic Care Sustainability Initiative, has been at the forefront of the effort to develop patient-centered medical homes in Rhode Island. Providence Business News asked her to share her insights about where this effort currently stands.
PBN: Where does Rhode Island stand in the effort to develop patient-centered medical homes as the norm for the delivery of health care services?
GIFFORD: Any successful attempt at an affordable health care system must put high quality primary care at its center. We are fortunate that Rhode Island is one of the states leading the primary care transformation effort in the country. Our work began in 2006 with the Chronic Care Sustainability Initiative, led by a multi-stakeholder collaborative. It includes all of our Rhode Island-based payers and Medicare, with 13 primary care sites working to transform [themselves] into highly functioning medical homes.
Blue Cross & Blue Shield of Rhode Island has subsequently developed its own program that will involve dozens of additional sites.
Thanks to these two initiatives, Rhode Island leads with country in the number of physicians per capita who are practicing in medical homes certified by the National Center for Quality Assurance, the nationally accrediting body for the patient-centered medical homes.
Despite this leadership, Rhode Island has a long way to travel before every Rhode Islander has access to a highly functioning medical home. Payers in some cases are waiting to see hard evidence of cost savings before making further investments. We need to develop a more permanent infrastructure for training and assisting practices in making the transformation. We need to be sure that Rhode Island is an attractive place for newly graduating primary care physicians to start their practices. All of this will take time – and continued investments on the part of payers, employers and providers.
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PBN: What have been the results? What has been achieved in terms of health outcomes, access and affordability?
GIFFORD: When our program began, the Commonwealth Fund awarded a grant to Dr. Meredith Rosenthal of the Harvard School of Public Health to study the outcomes. Rosenthal has been collecting data about the results, and we expect to see those results later in 2011 or early 2012.
In the meantime, our practices have been collecting their own data on changes in quality in their practices, showing important improvements in a number of key areas. For example, the percentage of diabetic patients whose blood pressure is in good control has risen from under 30 percent to more than 42 percent.
PBN: Your program has involved all the Rhode Island payers and recently earned new federal support under Medicare. How have the insurance companies been supportive of this effort?
GIFFORD: We have had outstanding collaboration with all of our local payers. Payers contribute a monthly fee to participating practices for each one of their members enrolled in that practice. They also pay for the salary and benefits of a nurse care manager who is located in the office, and is an employee of the primary care practice; it’s been a cornerstone of our program. Health plans also support the costs of managing the program by supporting the infrastructure costs of the multi-stakeholder collaboration, including the salary and expenses of the project management staff.
Working with the Office of the Health Insurance Commissioner, Rhode Island payers – including UnitedHealth Care of New England, Blue Cross & Blue Shield of Rhode Island, Tufts Health Plan, and Neighborhood Health Plan – are among the nation’s leaders in supporting the transformation of primary care.
We have just finished developing a “second round” of contracts between payers and medical homes, and the collaboration and cooperation among the parties was remarkable. We look forward to becoming one of eight states with whom the federal Medicare program is participating in a medical home pilot, which will begin later this year.
PBN: How much of the patient-centered medical homes’ success is dependent on adoption of health information technology and a willingness to collaborate as a team?
GIFFORD: We like to say that health information technology is necessary, but not sufficient, for the transformation of primary care. Because medical homes need to manage an entire population of patients, not just those patients that present for care at the office each day, the ability to track and identify patients electronically is a critical capability.
Teamwork is essential to a medical home. As our practices have gone through this transformation process, they are discovering new ways to form supportive care teams within the office, with expanded roles for each member of the primary care team. In addition, to fulfill the promise of the medical home model, specialists and hospitals must support and provide information to the primary care office so that the patient’s care can be coordinated across all of the settings in which they are receiving care. Hospitals, specialists, nursing homes and home health agencies are all a part of the “medical neighborhood” which is essential to making sure that care is truly “patient-centered.”
South County Hospital is testing a model of care in which the hospital serves as the “hub” of this neighborhood, and provides enhanced communication and supportive services to a number of its affiliated primary care practices.
PBN: How can businesses, large and small, become participants in patient-centered medical homes?
GIFFORD: The voice of the business community, as the ultimate financers of the care for their employees, is critical to this movement. The Rhode Island Business Group on Health has been working closely with CSI to promote the model and educate employers.
Employers can and should educate employees on the costs of health care and how their behaviors drive the costs.
Finally, employers can demand value-based benefit design from carriers that creates financial incentives for employees and their families to get their care at a patient-centered medical home.
It is our hope that business leaders will begin to demand that payers provide the level of care available at a patient-centered medical home as a way to improve care for their employees, slow the increases in their costs of providing coverage, and reduce unnecessary absenteeism and loss of productivity.
Employers can advise their patients to check for recognized medical homes either at www.pcmhri.org, or www.ncqa.org.
When purchasing coverage for their employees, businesses should ask how the insurer is working with and supporting their primary care practices to become medical homes, and how many medical homes are available in the payer’s network.
As consumers begin to demand the level of service only available through a medical home, we hope to see the model spread throughout the entire primary care community in our state.
