PCMH – What’s In It For Me?

11 May PCMH – What’s In It For Me?

The number of recognized Patient Centered Medical Home practices has grown significantly over the past few years, which is an exciting and promising trend for the healthcare system in our country. However, surprisingly, there are a number of practices that are still undecided about pursuing PCMH recognition, practices that have no intention of making the transformation, and practices still unaware of what Patient Centered Medical Home actually entails.

With what seems like an ever increasing workload for providers, managers, and staff it is reasonable for administrative teams to want to know “what’s in it for me?” I can personally relate to how it can be impossible to “see the forest through the trees”. However, it is important to understand that our healthcare system is moving toward a Consumer Based Model. Eventually patients will possess the power to “shop” for a high quality provider. Did you know that patients can already visit the CMS Physician Compare website to determine how fit you are to care for them? For practices that are well prepared; “to the victor will go the spoils.” Patients are hearing the message that PCMH practices have proven results in providing better quality of care, more involvement of the patient in their own care and, better patient experiences. As someone who was a Practice Manager for fifteen years, and personally tackled a PCMH transformation head on, I certainly understand the business need to know the immediate and long term financial rewards of implementing any new strategy.

Let’s break down a few items that should be considered:

  1. My recommendation is that you research everything your state offers; many already have PCMH initiatives in place. Some offer this through private payers, such as Michigan, in which Blue Cross Blue Shield offers increased reimbursement for designated practices, and additional incentives for quality and utilization. Several states also have Medicaid initiatives that offer PCMH incentives through increased per member per month payment.
  2. Numerous payers offer Provider Performance incentives based on quality scores, preventative care measures, and other items, which the PCMH model supports through Quality Improvement Measures.
  3. The more you know about your state’s strategy, the easier it will be to determine your specific, “what’s in it for me?”
  4. Make sure you know what your payers are offering to ensure you are taking full advantage of everything you can.
  5. If your practice doesn’t FULLY understand the dynamics of these programs, you are probably leaving much needed dollars on the table, instead of in your practice.
  6. With MACRA/MIPS recent release, we are all beginning to get a clear picture of what the future value based payment model will look like. Becoming PCMH recognized immediately gives you an advantage in the coming landscape. My fear is that those who don’t act now, will be losing valuable dollars in the very near future.

Point 6 may actually be the most important consideration, even though the immediate value could be difficult to see with everything else your practice is trying to juggle. As a provider or Practice Manager you may be thinking….. “The new payment model doesn’t begin until 2017, we’ll consider PCMH then”. This is true, MACRA/MIPS doesn’t begin until 2017, however the time for PCMH transformation in NOW! Depending on how a practice’s current policies and procedures align with the Patient Centered Medical Home model, it can take approximately 3-12 months to implement a PCMH. While this may seem potentially scary and daunting, it is necessary to achieve financial sustainability in the future.

It’s time to begin the path to better quality, better patient experiences and lower cost utilization.

It’s time to take advantage of the incentives available to providers who are devoted to quality improvement programs, and “whole person” care for their patients.

It’s time to be a part of transforming healthcare to the way it should be.

This article was originally published on RCM Answers and is republished here with permission.

Lisa Gouin

PCMH Services Manager at eHealthcare Consulting Inc.
With over 20 years of involvement in the healthcare industry, Lisa brings 15 years of practice management and practice transformation experience including responsibility for the overall success of Meaningful Use, PQRS and PCMH standards and goals. Lisa is a Certified Chronic Care Professional and has earned her NCQA PCMH Certified Content Expert certification.

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