Can the Patient Centered Medical Home Be Saved?

Posted by Michael Renzi, DO, FACP on Oct 10, 2017 9:01:00 AM

Yes – but only if insurers do their part.

Thousands of primary care providers transformed their practices to patient-centered medical homes in preparation for performance-based payment models. No doubt some groups submitted NCQA application for PCMH recognition status, but little changed in their day-to-day work flow. They just churned through as many patients as possible because their fee-for-service payments remained the key to their economic survival.

However, some of us actually made substantial investments in how we delivered patient care. We believed these new payment models promised to economically align payers, providers and, dare we even say it, patients. We examined and changed everything we did to prepare, with the full understanding that we were going to risk our payment if we missed the mark on quality and cost. We even considered alternative payment models (APMs), where we would pay money back to the payer if we missed the mark. Of course, these opportunities were touted to yield much bigger payments than the best of the fee-for-service contracts, but who would have ever “thunk it” -- doctors leaping head first into a risk-based payment model where they might have to refund payments to the payer for failure to meet cost benchmarks!

At first, it worked. High-performing practicesimprove patient outcomes and experience and lower the overall costs of care.[1] But in many markets, the APMs that would provide long-term economic sustainability to these high-performing groups never materialized.

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Topics: Value-Based Healthcare, Patient-Centered Medical Home, APMs

Straight to the top:  The right kind of “top of credentials”

Posted by Michael Renzi, DO, FACP on Nov 29, 2016 11:02:00 AM

One of the key requirements of VBC success—and one of the components of Industrial Strength medical practices—is the notion of all organizational staff working at the “top of credentials.” The most basic, agreed-upon definition of this idea has its roots in the medical home world, and essentially boils down to this: it’s an effort to offset workflow inefficiencies by getting the existing staff working mostly within their skillset. That seems like common sense, but practices tend to limit what a team member can do based on their certification, rather than what they could do based on their capabilities.

There’s a prerequisite before a practice even starts this top of credentials journey: to get these new tasks done by the right people, the right people need to be in the office in the first place. As practices struggle to maintain financial stability and fight margin erosion, adding more capable (and expensive) staff simply isn’t an economic option. Instead, we’ve got to look to how to increase capacity within the capability confines of the existing team.

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Topics: Patient-Centered Medical Home, PCMH, top of credentials

Coordinated Care and 7 Other Key Components of Practice Transformation

Posted by Continuum on Sep 26, 2014 1:53:00 PM

The verdict is in: a robust ambulatory care foundation is essential for the future of healthcare. Consequently, primary care practices must transform the way they practice medicine. While this transformation provides opportunities for improved care, a better patient experience and lower costs, it also presents significant and disruptive business and clinical shifts for providers.

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Topics: Practice Transformation, Coordinated Care, Value-Based Healthcare, Patient-Centered Medical Home

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