Transforming your practice into a medical home won’t require a down payment on new space – nor a remodel of the reception area. The “medical home”, originally defined by the American Academy of Pediatrics in the 1960s, is the collective support, communication, coordination and infrastructure a medical practice provides to its patients.
Although the medical home concept has been around for many years, its status has surged recently. The concept’s leap in popularity came in 2007 when Medicare began a medical home demonstration project. Private insurance companies soon followed by introducing programs of extra payments to medical practices that demonstrated that they served as a medical home for their patients. These extra payments now come in various forms: a “per member, per month” management fee for patients enrolled in the medical home; a reimbursement bonus per fee-for-service encounter; or entry into the top tiers of the company’s provider networks.
Regardless of the payment structure that aims to encourage a medical home, the results can be higher patient satisfaction and a better bottom line for your practice.
Will it work for your practice? Here’s how to find out.
Contact the insurance companies with which your practice participates. Ask what bonus programs they offer to medical practices that demonstrate they are a medical home.
Next, consider how you will prove your practice is a medical home. Many insurance companies look to third party recognition. The most widely accepted program is the National Committee for Quality Assurance (NCQA), Physician Practice Connections® - Patient-Centered Medical HomeTM recognition. The NCQA program defines the medical home as:
“… a model for care provided by physician practices that seeks to strengthen the physician‐patient relationship by replacing episodic care based on illnesses and patient complaints with coordinated care and a long‐term healing relationship.”
Primary care practices are not the only candidates; in fact, there is no specialty requirement to serve as a medical home. Obstetricians and gynecologists, for example, are strong and effective advocates of the concept. Patients suffering from chronic conditions such as asthma, diabetes, and cardiovascular disease may look for a medical home with a practitioner who is dedicated to managing their chronic condition.
The NCQA offers three level levels in its Patient-Centered Medical Home recognition. All require the medical practice to meet a majority of nine important care standards:
- Scheduling appointments and communicating with patients;
- Patient tracking and registry functions;
- Care management;
- Patient self‐management support;
- Electronic prescribing;
- Test tracking;
- Referral tracking;
- Performance reporting and improvement; and
- Advanced electronic communications.
Each of these nine standards contains between two and six elements upon which the practice is scored, and at least one element in each standard is considered a must-pass factor. For example, to meet the Care Management standard, the practice applying to the program would receive points for:
- Adopting and implementing evidence-based guidelines for three conditions (the must-pass element);
- Generating reminders about preventive services for clinicians;
- Using non-physician staff to manage patient care;
- Conducting care management, including care plans, assessing progress, and addressing barriers; and
- Coordinating care and follow-up for patients who receive care in inpatient and outpatient facilities.
Although it is possible to gain the NCQA’s lowest level of medical home recognition without an Electronic Health Record (EHR), the tracking, coordination and follow-up envisioned by medical home advocates are best-suited for an EHR.
The EHR has been a key tool for medical practices that embrace the medical home concept and consistently achieve its goals. This technology is especially supportive of the medical home concept because it allows multiple providers to access the patient’s record; ideally, these providers can access what they need to know regardless of the site of service. The electronic record can then seamlessly track encounters, test results, consultations, etc. That allows all providers to gain the information they need to provide better quality and better coordinated care.
Regardless of your specialty, a significant part of the success of a medical home is engaging the patient. A practice portal can extend information to the patient through a personal health record, which also can improve patient access to providers and engagement in better self-management of their care.
Creating a medical home also can enhance your working relationship with patients and provide a better structure in which to deliver quality care.
For medical practices that have honed their protocols related to communicating and coordinating care for patients, receiving NCQA recognition is an acknowledgement of their quality, as well as a potential means to receive extra payments from insurance companies.
For more details about scoring, costs and applying for Patient-Centered Medical Home recognition visit www.ncqa.org
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Features of Sage Intergy EHR, such as guideline-driven care, advanced clinical flowsheets and Drug Utilization Review can help your practice provide the care necessary for a Patient-Centered Medical Home. And the added communication options offered by the tightly-integrated Sage Intergy Practice Portal can help you and your patients share necessary information.
