Dr. Craig Samitt, president and CEO of Dean Health System, describes how the accountable care organization (ACO) can be part of the PCMH model.
The medical home encompasses the patient and all of the staff needed to support them. For example, most of the needs of a patient in primary care can be met by registered nurses (RNs) or medical assistants (MAs). Some of the basic needs and several of the major touch points are so minor that all they require is licensing by an RN. RNs can do a lot of work. How often do we let RNs do the work that RNs are trained to do? For anything that RNs cannot do, they certainly can be done by nurse practitioners (NPs) or physician assistants (PAs). The NPs and PAs should not be functioning at an equal capacity to physicians. We should concentrate our work for NPs on the tasks that they are best suited to do.
Family doctors are the core of the medical home and the traditional general practitioner that a patient would link to their panel. Internists are also included and are the most difficult to find right now. Our vision for a medical home may very well be a single internist that works with four family MDs, four NPs, four RNs and eight MAs. That would be a classic example of a medical home where that entire group focuses on the collective care of the patient. You would also have a social worker, a care or case manager for more complicated patients, and perhaps a chronic disease specialist. Most of the care that those patients would need from the medical community could be served by that group of providers. The medical home is just a subcomponent of the ACO. The ACO adds hospitalists, specialists and hospitals in combination with the medical home. In our view, the ACO is a medical neighborhood.
An important strategy is effective business development and marketing. Do you know where you want to grow, and how you need to grow? It is the Walgreens® strategy of healthcare, and we are doing that right now at Dean. We outsource services that don’t need to be done by our organization. Are you outsourcing transcription, revenue operations and IT? If you are not an expert at it, you probably should. It is certainly lower-cost that way. Also consider performance management, similar to that of GE® and the strategy of its former CEO, Jack Welch. We want the best and we have high expectations for rewarding the best.
The stimulus package has made it very clear that those organizations that use technology will benefit. We have wanted to put technology in wherever we can. And finally, we are seeking to be the first defect-free healthcare organization. There is a paradigm that better care equals more care. Actually, we believe that better care is lower cost; that in avoiding mistakes and doing things correctly the first time, we avoid costs and improve quality at the same time.
Source: Guide to Medical Home Reimbursement, September 2010
Guide to Medical Home Reimbursement
With data accumulating from dozens of pilots of the patient-centered medical home (PCMH) and federal legislation in place that will reward the PCMH and other team-based care delivery models in the months and years to come, healthcare organizations must be well-versed on reimbursement and physician incentive models that are driving results around the country. This resource delivers comprehensive analyses of emerging payment models for patient-centered care from early adopters that are working overtime to put a fair price on care coordination tasks and adequately reward providers for medical home adoption.
Guide to Medical Home Reimbursement is available from the Healthcare Intelligence Network for $369 by visiting our
Online Bookstore or by calling toll-free (888) 446-3530.
