Highmark to begin patient-centered medical home pilot

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.