7 ways Priority Health is using PCMH to help improve care for your employees

Although the term “Patient Centered Medical Home” is just one of the latest buzzwords included in health care reform speeches and now being introduced by some health plans, it isn’t a new concept for Priority Health. We’ve been providing programs and processes to expand access and coordinate care for more than 15 years – and we’re proud to continue to lead the charge today.

What is a patient-centered medical home?

The Patient-Centered Medical Home (PCMH) is an approach to providing comprehensive primary care for children, youth and adults. The PCMH is a health care setting that facilitates partnerships between individual patients and their personal physicians and, when appropriate, the patient's family.

Seven ways Priority Health is using PCMH to improve the health of your employees, while saving you money:

1. Reforming payment systems. First introduced in 1997, Priority Health uses quality-based provider incentives to improve both access and quality of care. For example, in 2009 we added provider payment codes for doctors who provided after hours care, e-visits, group visits and telephonic care.
2. Coordinating care. Priority Health began using patient registries more than a decade ago to help doctors identify care opportunities, which evolved to the nation’s first online patient registry, and continues to evolve today. Priority Health’s case managers take care coordination a step further by working closely with both doctors and patients to make sure members get the care they need, when they need it.
3. Supporting infrastructure reform. Our provider network team partners at both the practice and system levels to ensure communication and integration. They report financial results, educate on use of the registry, and review monthly dashboard reports with the physicians and staff.
4. Collaborating with Michigan State University. In 2010 we began working with MSU to compare the effectiveness of different PCMH strategies on improvement in outcomes including cost, quality and experience in pilot practices.
5. Providing PCMH grants. Since 2009 Priority Health has helped numerous practice sites become PCMH-certified by the National Committee for Quality Assurance (NCQA).
6. Assigning a PCMH to every member, regardless of plan. Research shows that members who have a primary care team in place have better clinical outcomes and an improved care experience. That’s why we assign a PCP to every member — to ensure they benefit from the medical home model.
7. Participating in the PROMETHEUS Payment® model. This innovative pilot program focuses on moving from single care encounter payments to one payment for an entire episode of care (known as “bundled payments”). The model offers strong incentives for clinical collaboration and efficiency, and shares the savings with doctors.

Topics: Member experience