Three key trends in PCMH staff model innovation are standing out from analysis of the Medical Home Project's benchmarking data:
This post is the second in a three-part series. Today, we will explore systems' use of centralized care management platforms—putting staff, expertise and systems into a network-level or corporate-level entity that extends support to physician practice sites, without their having to add all their own care management staff and functions.
Systems Focusing on Centralized Care Management Platforms
In addition to investing in medical home transformation at physician practice sites, some health systems—especially those that are actively working toward becoming accountable care organizations—are designing and investing in care management platforms housed at the system or network level to support practice-based medical homes.
Care management services available from these platforms vary, but can include:
- Prospective patient risk segmentation
- Health coaching and care coordination services for high-risk patients
- Nurse- or pharmacist-led medication reconciliation and medication management
- Post-discharge care transitions
- Consulting help for PCMH transformation
- Clinical IT support
- Support on quality improvement initiatives and reporting
Over time, I have seen this idea crop up more frequently among health systems working on medical home rollouts. It seems as though earlier PCMH initiatives were more focused on making whatever incremental changes were most feasible/acceptable in physician practices, letting each one determine best approach to care management. Process variability across practices was a low concern, and practices too small to support care management in-house could just opt out of the pilot.
Now that population risk has become a system-level strategic imperative, I hear much more emphasis on this idea of centralizing and standardizing care management services. Even those organizations that historically had a very decentralized model are now considering how to lift some of those services up out of the practice sites and re-orient them to work toward system-wide population management goals.
Today's motives include:
- Broadening medical home services across the entire network, including physician offices not large enough to support new dedicated FTEs
- Supporting both integrated and non-integrated practices (non-integrated practices can pay a fee to access support services)
- Standardizing care management protocols across diverse practice sites
- Leveraging the health system’s existing resources and expertise in areas such as quality improvement and clinical IT
- Using insight from across the care continuum into inform each patient’s care
Centralized care management services in practice
Existing case studies related to centralized care platforms for practice-based medical homes include:
We will be doing ongoing work in the area of care management services across coming months. (Please contact me if you would like to participate in the research.)
How common is centralized care management today?
Our 2011 benchmarking initiative captured a snapshot of care management service uptake among medical home practices by asking PCMH sites if key population management services were outsourced.
The results suggest that roughly a quarter of medical home sites are relying on external services for patient self-management support, population management data entry, and population data analysis.
Medical homes reporting "off site support" as primary owner of activity
- Patient self-management support: 18% (n=55)
- Population management data entry: 26% (n=53)
- Population data analysis: 32% (n=53)
Of course, this data leaves the question, "who is providing these services?" unanswered. In addition to health systems building care management platforms, payers and third-party vendors are also increasingly working to provide services like these.
Next in the staff model series, we will provide an update on the use of the "top of licence" principle to make all staff roles more robust.
Additional updates PCMH operations for the coming weeks will include:
- Population management activity in PCMH practice workflow
- PCMH access to clinical IT
- Panel size trends and benchmarks
Please make sure you are signed up for blog alerts for the Medical Home Project blog, The Blueprint. Please contact me directly if you would like to participate in our current research on care management services.