Currently, nearly 3,600 primary care providers (primary care physicians and nurse practitioners) participate in CareFirst’s PCMH program. One hundred-ninety six of the 297 eligible panels (66 percent) earned OIAs for the 2012 program year; 60 percent of panels earned OIAs in the program’s first year. The level of OIA for each Panel is based on both the level of quality and degree of savings achieved by the participants of the Panel.
PURPOSE: The patient-centered medical home (PCMH) model has great potential for optimizing the care of chronically ill patients, yet there is much to be learned about various implementations of this model and their impact on patient care processes and outcomes.
We examined quality, satisfaction, financial, and productivity outcomes associated with implementation of Care by Design (CBD), the University of Utah's version of the patient-centered medical home.
The US healthcare system has long been characterized as complex, fragmented, costly, and with significant variation in quality of care. During the health reform debate, many health policy experts have called for the country to reorganize healthcare providers and delivery systems through organizational or virtual integration. The concept of integrated healthcare delivery systems (IDSs) has gained considerable interest. Such systems have been viewed as a better approach to addressing the issues of quality and cost.
Since 2010, the number of PCMH providers in NYS has increased from 633 to 4,461. As of mid-2012, over 1.4 million Medicaid managed care (MMC) and CHPlus enrollees are assigned to PCMH providers. In 2011, about 75,000 Medicaid fee-for-service (FFS) members had a visit with a PCMH provider. For the first six months of 2012, this number increased to 84,000. As this number represents unique recipients and not visits, there is no expectation that the number for the full year will double or increase substantially.
High-Intensity Primary Care Payment: Good Return on Investment for Employers
As the largest purchaser of health care in America, employers are paying a high price for care of variable quality. To check soaring costs, some employers are switching from the inefficient fee-for-service model of paying for care, which encourages high volume and low quality, to payment models that reward high value.
