3 Key Takeaways from our Growing Support for PCMH Hangout

December 17, 2015 · NCQA

1. Ongoing, adequate financial support is essential for payers and patients alike to get the benefits and significant return on investment that PCMHs provide.

More insurers are supporting Patient-Centered Medical Homes, but most pay less than what practices need to sustain PCMH transformation. That was the focus of a popular Google Hangout on PCMH Incentive Growth NCQA hosted Dec. 16. NCQA President Margaret O’Kane lead the discussion by highlighting NCQA research that found the number of PCMH incentive programs has grown from 26 in 2009 to over 160 today. However, most payments are below the roughly $5 per-member-per-month an Annals of Family Medicine study suggests it costs to provide the extra PCMH services.

2. PCMHs have the potential to provide even more benefits, such as meeting many unmet behavioral health challenges by integrating behavioral care into their practices.

The Hangout also featured that study’s authors, University of Utah’s Michael Magill and Debra Scammon, and Avista Adventist Hospital/Centura of Colorado’s Health David Ehrenberger. Magill stressed that insurers must make ongoing PCMH investments to get the substantial return on those investments, which ranges from 2.5 to 1 to up to 6 to 1. Scammon added that, to accurately assess costs, they had to ask all staff members about the additional work the team-based PCMH model requires. Ehrenberger emphasized PCMHs important potential to address even many unmet behavioral health challenges through an innovative approach to integrating behavioral care into their practices.

3. PCMH incentives consider not just the cost of the PCMH model, but the value and savings PCMHs provide to the entire health system.

Ongoing, adequate support is essential for payers and patients alike to get all the benefits PCMHs provide, said O’Kane. Per-member-per-month payments, the most common identified in NCQA’s research, can give practices the sustained and predictable resources they need to hire additional support staff, implement electronic health records, and provide the expanded access and care coordination that are PCMH hallmarks. Shared savings models that reward PCMHs for reducing hospital admissions, emergency department visits and other avoidable care, hold the most promise, she added. In fact, concluded Magill, insurers should base PCMH incentives not just on the cost of the PCMH model of care, but “on the value they provide” to the entire health system.

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