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Health Care Leaders to Use New National Criteria for Patient-Centered Medical Home

Employers, physicians, policymakers adopt NCQA attributes for

primary care medical practices to improve health care

WASHINGTON, Nov. 7 /PRNewswire-USNewswire/ -- The Patient Centered Primary Care Collaborative (PCPCC), a coalition representing the country's national business leaders, policymakers and 330,000 primary care physicians, today announced its intent to use a set of clinical and operational criteria that will allow primary care practices to voluntarily be recognized as patient-centered medical homes. The criteria, developed by the independent National Committee for Quality Assurance (NCQA), were announced at a national health care summit sponsored by the PCPCC.

NCQA, in concert with the American Academy of Family Physicians, American Academy of Pediatrics, American College of Physicians and American Osteopathic Association, established the criteria such that physicians could be designated as a medical home. The new designation programs will be piloted in January 2008; they set the stage for improving the quality of health care in the United States.

"The medical home puts the emphasis on the patient-doctor relationship where it belongs -- and helps doctors work to keep patients healthy instead of just healing them when they are sick," said NCQA President Margaret E. O'Kane. "Systematic approaches to care have been shown to improve health care quality and patient satisfaction."

The patient-centered medical home concept re-centers health care on the patient's needs and priorities by providing primary and preventive care that is personalized for each patient. It emphasizes the use of health information technology, including electronic health records, to help prevent and manage chronic disease and features consumer conveniences such as same-day scheduling and secure e-mail communications. The medical home strengthens the patient-physician relationship by allowing the doctor and team of health professionals to spend more time with each patient and to develop and follow through on an individualized plan of care.

A practice recognized as a patient-centered medical home would receive compensation for the time and work physicians spend to provide comprehensive and coordinated services. This approach is distinctly different from the current system which pays for procedures and treatment of individual diseases rather than valuing and encouraging treatment of the whole patient, preventing chronic illness, and managing multiple, interrelated and ongoing health problems.

Primary care studies have demonstrated they deliver improved health outcomes at lower costs.

-- Experience with Community Care of North Carolina -- the state's Medicaid program in which 3,500 primary care physicians participated in community-based networks based on the medical home concept -- showed significant improvement in quality and cost outcomes through disease management, evidence-based clinical practice, and an emphasis on a physician-led team approach. North Carolina Gov. Mike Easley recently released data showing that Community Care of North Carolina saved the state a combined total of more than $231 million in Medicaid costs for fiscal years 2005 and 2006.(

-- A 2006 Commonwealth Fund health care quality survey found that when adults have a medical home, racial and ethnic disparities in access to care and quality are reduced or even eliminated and rates of preventive screenings improve substantially.

-- Patient-centered primary care programs at IBM achieved high patient satisfaction and significant savings. When compared to industry norms, IBM health care premiums are 6 percent lower for family coverage and 15 percent lower for single coverage, and IBM employees pay 26 percent to 60 percent less overall.

"IBM found that employees who use a patient-centered primary care approach enjoyed better health at lower costs," said Paul Grundy, M.D., chairman of the PCPCC and director of Healthcare Technology and Strategic Initiatives at IBM. "This new model of care will help businesses looking to improve quality, achieve high employee satisfaction and contain health care costs."

Many political leaders support the medical home approach to patient care. A growing number of state governments are interested in incorporating medical home models into the health care programs they fund. Seventy-seven bills incorporating different facets of the medical home model have been introduced in the District of Columbia and 21 states, including California, Illinois and Texas.

Newt Gingrich, former Speaker of the U.S. House of Representatives, and Representative Patrick Kennedy (D-RI), joined with the PCPCC to call for adoption of the medical home concept.

"Technology, prevention and consumer-centered care are the powerful forces necessary to transform health care into a 21st Century Intelligent Health System," said former Speaker Gingrich. "It is absolutely imperative that we embrace this new model of care, centered upon the individual, in order to save lives and save money for all Americans."

"Our health care system is not a health care system, it is a sick care system," Kennedy said. "We can bring down costs by investing more in prevention and care coordination, which are hallmarks of the patient-centered 'medical home' model."

The new NCQA criteria were outlined at a summit of the Patient Centered Primary Care Collaborative, which is led by a steering committee of the American Academy of Family Physicians, American Academy of Pediatrics, American College of Physicians, American Osteopathic Association, Aetna, BlueCross BlueShield Association, Cigna, CVS Caremark, The ERISA Industry Committee, Humana, Inc., IBM, Medco, UnitedHealthcare, Walgreens and WellPoint Inc.

The Patient Centered Primary Care Collaborative is a coalition of more than 40 major employers, consumer groups, organizations representing primary care physicians, and other stakeholders who have joined to advance the patient-centered "medical home." The Collaborative believes that, if implemented, the patient-centered medical home will improve the health of patients and the health care delivery system. For more information on the patient-centered medical home and a complete list of the PCPCC members, please visit

SOURCE Patient Centered Primary Care Collaborative
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