Employer Perspective

THE PCMH A MORE COST EFFECTIVE AND EFFICIENT MODEL OF HEALTHCARE

ISSUE: The current American health system contains substantial inefficiencies. Among them is the over reliance of American patients on specialized practitioners. This leads to excessive and inefficient cost structures that reward duplicate x-rays, unnecessary tests, multiple consultations with differing specialists, and other ancillary procedures.

Meanwhile, as specialist fees and salaries increase, those of primary care practitioners decline. But the primary care physician has the ability and inclination to consider the holistic health condition of his patients.  It is widely agreed upon in the health industry that recipients of primary care live longer, healthier lives

THE PCMH: The PCMH will broaden access to primary care physicians, while expanding and enhancing their role as a central care coordinators:

• They will take personal responsibility and accountability for the ongoing care of patients;
• They will be accessible to their patients on short notice, for expanded hours, and open scheduling;
• They will be able to conduct consultations through email and telephone;
• They will conduct regular check-ups with their patients to identify looming health crises and initiate treatment/prevention measures before costly, last-minute emergency procedures are required;
• They will advise their patients on preventative care based on environmental and genetic risk factors they face;
• They will help patients make healthy lifestyle decisions; and
• When specialist care is needed, they can coordinate those services, making sure they are relevant, necessary, and performed efficiently.

HOW TO GET THERE: The key to this model is restructuring physician reimbursement to incentivize the nature of care described above.

• Compensation for face-to-face consultations, as well as ones conducted over email and telephone;
• Compensation for services associated with the coordination of specialist care, and the monitoring of test results and procedures performed by specialists;
• Implementation of a hybrid model of payment;
• fee-for-service based on hours of contact with patient; and
• performance based incentives, including sharing emergency room cost savings and compensation for achieving measurable and continuous patient health improvements.

PRODUCT: The result of this model will be:

• Healthier patients;
• Savvier consumers of health care;
• Patients who make healthier lifestyle decisions;
• Drastically reduced costs associated with coverage; and
• Empowered patients, who have a robust relationship with their physicians. 

 
In the North Carolina Medicaid program where this model was implemented, independent evaluations have shown a high level of patient satisfaction—including improved handling of chronic care patients—and significant cost savings.