Why PCMH?

Why PCMH?

We get this question a lot.

Patient-Centered Medical Homes (PCMH) have gained support from both private & public healthcare sectors,and we are encouraged by their growing success. PCMH is a way of organizing primary care that emphasizes:

  • Access

  • Team-based care

  • Population health management

  • Care management & support

  • Care coordination

  • Performance measurement

  • Communication (& more!)

Implementing PCMH principles improves process & quality in primary & specialty care. The goal is to help healthcare organizations achieve higher measures of quality, improve patient outcomes, & implement processes to improve reliability & appropriateness of care. PCMH is here to stay, so here’s what you need to know:

 

It’s Not as Bad as You Think (or Fear)

It’s true, there’s a good bit of documentation required to get PCMH Recognized & it will take some work, but it is attainable for organizations of all sizes. You can do it - it just takes some focus & the right guidance.

 

What does PCMH do for my organization?

There are numerous benefits to becoming a PCMH Recognized healthcare organization, particularly when it’s done properly. They include:

  • Enhance financial reimbursements & contracting

  • Quality improvement

  • Improved patient outcomes

  • Improve patient & care team experience

  • Marketing & PR opportunities

  • Drive patient visits to your practice

  • Take advantage of additional billable services

  • Increase patient loyalty

PCMH helps organizations provide more effective care & optimize the use, timeliness & appropriateness of services.

“Our clients & many other healthcare organizations already provide excellent care & they’re passionate about their patients. With PCMH, they are able to better document their outcomes & get reimbursed for their efforts,” says Clarify’s CEO, Amber Winkler.

 

Build the Foundation to Survive in a more Data-Driven Healthcare Environment

We strongly encourage clients to focus on making data-driven decisions.

PCMH sets a foundation for high quality reporting measures. Reporting data is a critical component to PCMH, but also to the overall success of any organization in healthcare. Without good data & capable reporting systems, organizations are in the dark about their patient populations, quality, finances, & outcomes.

Reporting data is critical to providing high quality care, is directly & increasingly tied to reimbursement, & allows you to prepare well for MACRA, MIPS, & APMs. The time is now, it’s not in several years.

 

PCMH by the Numbers

PCMH Recognition has both short & long-term benefits. The evidence shows PCMH is:

  • Proven to lower overall healthcare costs

  • Provide a high return on investment (ROI) to become or maintain PCMH Recognized.  (Most organizations see a 6 to 1 return on their PCMH investment)

  • Studies in 2015 showed a reduction of 11% in ED visits for Medicare patients Studies show patients seen at PCMH Recognized practices have fewer prescription errors & fewer avoidable ED visits. (orth Carolina saved $382 million in pharmacy costs in 2011)
  • Lower member per year or month costs to insurance companies. South Carolina saw a 6.5% drop in PMPM medical & pharmacy costs in 2011.

  • Leads to lower Medicare claims, ambulatory care & significant decreases in ED visits.

  • Long-term PCMH implementation produces largest sustainable cost savings in acute inpatient care.

  • Produce lower overall healthcare costs due to focus on primary care utilization.

  • At Clarify, we’ve seen primary care costs increase, while the patient’s overall healthcare costs decrease.
  • Patients with chronic disease(s) seen for an average of 4 more times per year. That’s good stuff!

 

The Process

Please understand that effort has to be made to achieve the results you desire from your PCMH Recognition, but it is worth it. If an organization fails to make meaningful changes in their practice, they may not get the results they’d like immediately. That’s really not surprising. When a practice makes improvements or becomes more aware of processes in how they deliver care, they get results, their numbers improve, & it is rewarding. We love talking to our clients about it.

Achieving PCMH Recognition can be tough, but we believe the benefits greatly outweigh the effort. Plus, it gives you a chance to see & be proud of what you’re doing well, & identify some opportunity areas you may not be aware of - we see it all the time. It’s all growth & it’s positive. PCMH provides organizations with great opportunities to show their practice cares about quality, patient relationships, & being sustainable & successful.

PCMH helps organizations provide the care patients deserve & need - reliable processes, empowered teams, improved quality, & follow-up. It’s just the right thing to do. The great part is it also makes business sense.

Contact us at Clarify to become PCMH Recognized & to put population health management to work in your practice. Visit our website for more information.

To see incentives & benefits for becoming PCMH Recognized by state, click here.

Sources: NCQAPCPCC