Historically underserved populations such as Medicaid beneficiaries often have serious problems accessing comprehensive, culturally competent, and coordinated primary care, especially proactive chronic care. Fee-for-service payment systems provide virtually no added reimbursement for such services, negatively affecting incentives of overworked primary care physicians, to provide them. Thus, these populations experience poorer outcomes and higher costs than those experienced by better served populations. To address these problems, the patient-centered medical home (PCMH) has been proposed as a new primary care model. The PCMH represents a whole-practice redesign emphasizing values of access, continuity, comprehensiveness, and coordination, promoting the chronic care model, using sophisticated information technology, and realigning reimbursement models to improve access and outcomes. The PCMH model has met with great enthusiasm;however, in most venues valid data on the PCMH's ability to improve outcomes while controlling costs are quite sparse. In 2007, CareOregon, a nonprofit Medicaid managed care plan in Portland, worked with selected primary care practices that see its members to implement the Primary Care Renewal (PCR) project. PCR provides reimbursement and other support to encourage practices to provide multidisciplinary, coordinated, comprehensive care. Participating practices agree to implement team-based and customer-driven care, barrier-free access, proactive panel health improvement, and onsite or otherwise integrated behavioral health. Internal performance assessments lead CareOregon to believe that PCR is having early success on certain quality metrics. By extension, we believe that the PCR experience is useful for identifying, describing, and ultimately disseminating techniques of transforming primary care in highly beneficial ways to patients, providers, and health care systems generally. Our objectives are to 1) validate quantitatively healthcare quality improvements at participating practices after PCR transformation;2) identify and describe qualitatively contextual and organizational factors that contributed to the successes in 1);and 3) execute a broad-based dissemination plan to reach the widest possible audience of organizations potentially interested in medical home implementation.
The patient-centered medical home (PCMH) has been proposed as a model for primary care. The PCMH Transformation project evaluates which elements of safety-net primary care practices contribute to successful transformation to patient-centered care. We will examine how such transformations affected quality of care and overall health-care costs for Medicaid populations served by these clinics. Our findings will be valuable to primary care clinics and Medicaid health plans aiming to improve quality of primary care while avoiding unnecessary hospitalizations and emergency department visits.
| McMullen, Carmit K; Schneider, Jennifer; Firemark, Alison et al. (2013) Cultivating engaged leadership through a learning collaborative: lessons from primary care renewal in Oregon safety net clinics. Ann Fam Med 11 Suppl 1:S34-40 |
