Medical Homes

Medical Homes have been increasingly embraced by stakeholders as a key component of 21st century healthcare delivery. The ongoing challenge is to demonstrate the quality and value derived from the care delivered by patient-centered medical homes.

During the week of November 5th, Medical Home News, MCOL and Payers & Providers jointly sponsored an online survey to ask industry stakeholders their perspectives on patient-centered medical homes.

Participants were asked to respond to eight questions:

1.Please categorize your organization: provider, payer or pendor or other

2.How has your organization's involvement with medical home issues in 2012 differ from 2011?

3.Do you think that widespread adoption of the medical home model would: increase quality and lower costs, increase quality but also increase costs, or have no effect on quality?

4.What is the single most important issue to overcome in terms of widespread implementation of the medical home model?

5.How do you view accountable care organizations?

6.Are you currently part of an ACO?

7.From whom do you get special reimbursement for care coordination?

8.What grade would you give the Centers for Medicare and Medicaid Services in advancing the concept of medical homes and patient-centered care?

The results of this survey showed a large majority of respondents said their organizations involvement with medical home issues has increased since the previous year. A record number of respondents, 79.3%, said their organizations' involvement in medical homes had increased.  Another 17.4% said their organization's involvement with medical home issues was the same as the previous year.

Only 1.1% of respondents said their involvement decreased from last year.

When broken down by respondent category, there was some variation. Those who categorized their organization as vendor or other (4.8%) were the only respondents to say their involvement with medical home issues decreased.

Providers were the most likely to say their involvement increased (85.7%). That was almost ten percentage points more than payers and almost twenty percentage points more than those in the vendor or other category.

Impact on Quality

What respondents think the effect on quality from the widespread adoption of the medical home was consistent with previous years.

Sixty-three percent believe widespread adoption would increase quality and lower costs. About a third of respondents (33.7%) think medical homes would increase quality and increase costs. Only 3.3% think widespread adoption will have no effect on quality.

Only providers, at 6.1%, thought that widespread adoption would have no effect on quality. Payers were the most likely to think that costs would increase along with quality at 40.9%, just over ten percentage points more than providers.

For the fourth year in a row, lack of payer commitment to reimburse care coordination was cited by a plurality (46.7%) of respondents as the single most important issue to overcome in terms of widespread implementation of the medical home model.

Obstacles

The growing shortage of primary care physicians was singled out by 21.7% of respondents as the most important issue to overcome toward widespread medical home adoption. Lack of sufficient team culture being was cited by 12% of respondents; lack of incentives to adopt and implement EHRs was cited by 8.7%.

A majority of providers and those in the vendor or other category (59.2% and 52.4%, respectively) thought lack of payer commitment to reimburse care coordination was the most important issue to overcome in order to establish patient-centered medical homes, while payers disagreed with this assertion, with only 13.6% responding this way. Payers had no issue which a majority agreed on; however, 31.8% thought the growing shortage of primary care physicians was the most important issue to overcome.

Views on ACOs

Respondents were asked to list how they view accountable care organizations by checking all answers that apply. The only response that was  listed by a majority of participants was that ACOs need medical homes as their foundation or they won't succeed.

Nearly a third of respondents (32.6%) said ACOs will ultimately be squeezed by the commercial plans for cost savings like the old days of managed care; 25% believe medical homes will only take hold once Medicare and Medicaid are full players; and 16.3% think that they are just a current fad and will not be the delivery system of choice.

The biggest variation among categories on their view of ACOs was whether they will be more difficult  to form than the general consenus. 

Those in the vendor or other category were over twenty percentage points more likely than providers and over twenty five percentage points more likely than payers to say they will be more difficult to form than most people believe (61.9%).

Payers and providers were mainly in agreement on how they view ACOs. However, payers were 8.5 percentage points more likely to see PCMHs as a needed foundation for an ACO's success and that providers were 14 percentage points more likely to say commercial plans will squeeze them for cost savings.

A large majority of the respondents – 78.3% – said they were not part of an ACO at thetime of this survey, though 50% of those plan to eventually be part of one. Only 21.7% of respondents said they are currently part of an ACO.

Providers were the most likely to be part of an ACO (30.6% in total), with an additional 40.8% saying they plan to be.

Payers were the least likely to be part of an ACO, though 50% plan to be. Those in the vendor or other category were the least likely to be part of an ACO (61.9%).

Care Coordination

A majority of respondents (62.6%) do not get special reimbursement for care coordination. Only 12.1% said that Medicare and several commercial plans reimburse them for care coordination, while 7.7% were reimbursed from Medicaid and 5.5% said they were  reimbursed by one commercial plan.

Providers were the most likely to be reimbursed for care coordination (46.9%). They said that either Medicaid (10.2%), Medicare (12.2%), one commercial plan (6.1%) or several commercial plans (18.4%) reimbursed them.

Only 23.8% of payers said they were reimbursed for care coordination, mostly (14.3%) from Medicare. 28.6% of those in the vendor or other category were reimbursed for care coordination with 9.5% each saying it came from Medicaid, Medicare or several commercial
plans.

CMS Gets Better Grades

A majority of respondents (53.8%) would give CMS a grade of ”A” or “B” in advancing the concept of medical homes and patient-centered care, which is up from 37.9%  in last year's. However, only 13.2% of respondents gave CMS an "A."

Respondents giving CMS an “F” was up one percentage point from last year (4.4%), although grades of “D” (12.1%) and “C” (29.7%) were both down from last year.

Payers and providers were more likely (at 13.6% and 14.6%, respectively) than those in the vendor or other category (9.5%) to give CMS an “A” grade. However, those in the vendor or other category were more likely to give a grade of an ‘A’ or ‘B’ (61.9%), compared to providers (54.2%) and payers (45.5%).