UPMC Patient-Centered Medical Home Model

The UPMC Health Plan is part of a large, integrated delivery and financing system headquartered in Pittsburgh, Pennsylvania. From 2008 through 2010, sites participating in the plan’s PCMH pilot achieved lower medical and pharmacy costs; and lower utilization of services such as ED visits, hospital admissions and readmissions. The plan also experienced a 160 percent return on the plan’s investment when compared with nonparticipating sites. As part of the initiative, UPMC provided each participating site with a practice-based nurse care manager, who was trained and employed by the health plan. Six care managers were assigned to the ten sites and were made available by telephone and electronically to their assigned practices, regardless of which office they were in at any particular time. Practice-based care managers provided care management support at the participating sites for certain high-need members with one or more chronic conditions, including diabetes, heart disease, depression, and asthma. Members were identified as high need based on a risk-stratification methodology that combined data from a variety of sources.