Highmark Inc. is working with 13 physician  practices throughout Western and Central Pennsylvania and West Virginia on a  pilot program that establishes patient-centered medical homes (PCMH) in which  physicians take greater accountability for coordinating care for their  patients. The program will begin June 1. The 13 practices will include 29  different locations, 160 physicians and will about 45,000 members.

“Identifying the right providers is key to  the success of a medical home,” says Dr.  Mary Goessler, medical director of Quality Management, at Highmark Inc. “Doctors  who embrace working as part of a team, with the doctor as the lead, and  holistic care of the patient are the most successful. Care coordination by a  registered nurse is another key element of this concept, and many primary care  practices are recognizing the value added by these professionals in caring for  their population of patients rather than just those who make appointments to  come into the office.” 

Under Highmark's new approach to care, PCP  reimbursement will be modified to provide compensation to help fund the  practice's transformation to a patient centered medical home. Fundamental to  the model, according to the company, is the implementation of care  coordination, patient information transfer and clinical outcomes-based  reporting.

“While many physicians have heard about  medical homes, having the knowledge and resources to transform their practice  into a medical home is not as widely understood,” Goessler says. “In 2011, a practice that is attempting to  transform their care to this model needs to have a robust EMR (electronic  medical record system), as information and data exchange with specialists, labs  and hospitals where patients have received care so that all the person’s  medical information has a ‘home’ is essential.” 

When a patient is transitioned from one  care setting to the next, communication breakdowns can result in medication  errors, duplicate tests and services and lack of proper patient follow up.  Through better management and coordination of care, Highmark anticipates fewer  hospital readmissions and reduced emergency room visits.

Highmark anticipates this new delivery model  will help to improve and sustain optimal clinical outcomes and begin to  positively impact healthcare cost trends. It will be considered for broader  implementation throughout the Highmark primary care network, once data of the  two-year pilot is assessed.

Highmark Inc. is working with 13 physician practices throughout Western and Central Pennsylvania and West Virginia on a pilot program that establishes patient-centered medical homes (PCMH) in which physicians take greater accountability for coordinating care for their patients.