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Patient Centered Primary Care Collaborative Releases New Guidelines for Health Care Purchasers
Date:4/16/2008

Framework includes sample RFI language, advantages of buying care that reflects patient centered medical home concept

WASHINGTON, April 16 /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 introduced a framework for health care purchasers to buy health care that reflects the patient centered medical home (PCMH) philosophy. PCPCC is organized and financed to provide better outcomes for patients, more efficient payment to physicians and better value, accountability and transparency to purchasers and consumers. The PCMH model saved one state Medicaid program between $118-130 million in a single year according to program analysis by Mercer Government Human Services Consulting. Other studies show the model improves patient satisfaction and clinical outcomes.

A critical chapter of the organization's Employer Purchaser Guide was released today in conjunction with the PCPCC's Stakeholders Working Meeting, held at the Ronald Reagan Building in Washington, DC. The chapter illuminates six strategies purchasers can use to advance the PCMH model:

Participate in a regional pilot(s) supported by PCPCC;Incorporate PCMH into insurer procurement and performance assessment activity;Align payment strategy with PCPCC guiding principles;Build coalitions in support of the PCMH;Engage consumers; andIntegrate PCMH into other corporate health strategies.

The purchaser guidelines are part of the overall efforts of one of the PCPCC's working groups, the Center for Benefits Redesign and Implementation, to produce a document to introduce purchasers to the history and philosophy of the PCMH. When complete, the Employer Purchaser Guide will define the concept, make a case for the employer's role in support of the medical home, describe how employers can take action now, and provide the tools to purchase health care based on the medical home concept, as well outlining case examples of activities throughout the country.

The report is co-produced by PCPCC and the National Business Coalition on Health, a national membership organization of employer-based health care coalitions. The chapter of the report released today contains the action steps purchasers can take now to advance the PCMH concept, including a standard health plan Request for Information (RFI) document.

"We are starting with the chapter about action steps that purchasers can take because that is what everyone wants to know. The definition, rationale and economic benefits of PCMH have been described by others and we will address those issues next," said Dennis White, NBCH's senior vice president for value-based purchasing. "We are excited about this initial draft, because it addresses the many health benefit variations exhibited by purchasers, while tackling some issues of PCMH structure that purchasers need to consider. Some of these issues will affect the performance of the PCMH. This is a complicated issue because there are different types of purchasers, from those who are self-insured to those who rely heavily on the health plans, and including those who go their own way to develop their own programs. We're trying to hit on all the cylinders and give every purchaser the tools to support the patient-centered medical home now."

White emphasized today's release is a preliminary draft and that feedback and further contributions are invited. The full Employer Purchaser Guide is expected to be released in mid-May.

"When complete, this guide will offer key characteristics that employers should look for when working with their health plans to implement the patient centered medical home," said Edwina Rogers, PCPCC's executive director and vice president of health policy, The ERISA Industry Committee. "The chapter released today includes guidance in three broad areas: purchasing criteria and metrics, financial incentive and disincentive strategies, and benefit design recommendations."

The guide is expected to gain widespread attention from large employer purchasers, as well as from health plans.

"When it comes to purchasing health care, employers should ask their health plans key questions to evaluate support for the patient centered medical home," said Paul Grundy, MD, chairman of the PCPCC and director of Healthcare Technology and Strategic Initiatives at IBM. "Important initial measures they should track are network development efforts that encourage PCMH certification, case management adoption rates among primary care sites, the number of primary care visits at certified practices and the health network use of enhanced reimbursement models that support the patient centered medical home."

"Health plans play an important role in engaging consumers and providers, aligning incentives and supporting community collaborations," Grundy added. "We fully expect them to work collaboratively with employers to implement the strategies outlined in this guide."

Today's meeting spotlighted reports from all the PCPCC's Centers: Center for Multi-Stakeholder Demonstration, Center to Promote Public Payer Implementation, Center for Health Benefit Redesign and Implementation, and the Center for eHealth Information Adoption and Exchange. Leading experts in the field, including David Meyers, MD, director of the Center for Primary Care, Agency for Healthcare Research and Quality and Len Nichols, director of health policy program, New America Foundation, addressed current legislative activity around the medical home concept, as well as the role different stakeholder groups play in the process--purchasers, payers, consumers and providers.

"This is a very important working meeting for the Collaborative to focus on organizing our continued efforts to promote the patient centered medical home concept," Rogers said. "The Collaborative Centers are each charged with carrying forward interlocking pieces of the patient-centered primary care picture, which work together to bring better coordinated, more effective health care for consumers."

For a complete meeting agenda, go to http://www.pcpcc.net/content/april-16th-stakeholders-working-meeting-agenda .

To access the Purchaser Guide go to: http://www.pcpcc.net/content/purchasers-guide

About the Patient Centered Primary Care Collaborative

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 http://www.pcpcc.net/.


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SOURCE The Patient Centered Primary Care Collaborative
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