The skilled nursing facility (SNF) industry is an important area for Medicare accountable care organizations (ACOs), Medicare Advantage health plans, and other Medicare programs. How can these organizations appropriately benchmark performance to provide efficient healthcare and reduce spending for SNF services?
Milliman’s Jill Herbold and Anders Larson offer some perspective in their report “Performance of skilled nursing facilities for the Medicare population.” The report highlights several utilization and expenditure metrics for measuring SNF performance. It also explores SNF performance levels across the United States and provides a quantitative assessment of the opportunities to reduce spending for SNF services.
Although the concept of a patient-centered medical home (PCMH) has been around for more than 50 years, the last decade has seen a revitalization of the PCMH model and an increase in its presence across the nation. The model’s popularity hinges on an approach to providing comprehensive primary care and redesigning healthcare delivery processes. This is accomplished through an emphasis on team-based care delivery, a whole-person approach to patient care, collaborative relationships between individuals and their physicians, and the use of evidence-based medicine and clinical decision support tools.
In 2007, four nationally recognized physician organizations identified seven principles considered foundational to the PCMH model:
1. Personal physicians
2. Physician-directed medical practices
3. Whole person orientation
4. Coordinated/integrated care
5. Quality and safety
6. Enhanced access
7. Payment reform
Although the foundational principles of the PCMH have been largely agreed upon, there is no clear model for how to create a successful PCMH. One of the most widely recognized models in place today is sponsored by the National Committee for Quality Assurance (NCQA), though there are numerous different demonstration and pilot projects in process across the country. As stated in the Journal of General Internal Medicine paper “Defining and measuring the patient-centered medical home”:
“…The context for operationalizing the PCMH is still evolving based on what is being learned in many ongoing demonstrations,” underscoring the importance of evaluating and incorporating unique geographic, demographic, and economic considerations into the design of any new care model.
Successful care delivery transformation projects, especially PCMH implementation and sustaining activities, require significant emphasis on healthcare analytics to inform quality improvement activities in addition to managing cost and utilization control efforts. The use of structured and routine analysis of information from healthcare claims enables both established organizations and newly developed PCMHs to receive ongoing feedback on process effectiveness and health outcomes, facilitating rapid-cycle process improvement across the organization.
PCMHs typically focus their analytic resources on operational process improvements and patient outcomes, with the goal of driving improvements in support of the “Triple Aim.” Successful organizations understand that routine and actionable information is the key to driving improvements. Examples of PCMH-focused analytic approaches being used across the country, which typically focus on cost, utilization, and quality, include but are not limited to the following:
The New York Times considers the perception problem facing medical homes. Here is an excerpt:
Call it a P.R. issue, an information disconnect or simply an unfortunate choice of a name, but in all the discussions about patient-centered medical homes, one group of individuals has been conspicuously missing: the patients themselves. And it’s hard not to notice the irony; in a model of care premised on the strength of the patient-doctor relationship, few people other than doctors and experts are even sure what it is or how it affects their care.
Now, as dozens of pilot projects across the country are transforming traditional doctors’ offices into medical homes and putting this theory of practice to the test, one thing has become apparent: even this most promising of reforms is unlikely to take hold without the active involvement of patients.
If patient awareness is the problem, what is the solution? How about medical home scenarios that work. Here’s one: Hypertension.
A new report sheds light on the medical home model by looking at how medical homes can be used to treat hypertension (HTN), which is “the most common primary diagnosis coded on medical claims” and is often paired with another condition. These patients “are challenging for physicians to manage as they have higher prevalence of comorbidities compared to non-HTN patients.”
How, then, should hypertension be treated? The key is to keep blood pressure under control, and a medical home can help do that. A survey conducted by the Commonwealth Fund found that “hypertensive adults with a medical home are substantially more likely to have their blood pressure under control.”
Medical homes for hypertension face challenges in how they are structured, however. This report examines four such challenges:
1. Adjusting payments so that the patients with high demands generate higher medical home payments.
2. Coordinated information and treatment plans across physicians and other providers so the patients with multiple sources of care get treated appropriately without gaps, conflicts, or redundancies.
3. Use of Allied Health Service professionals, remote monitoring, telephonic interactions and email to better manage complex patients and to reduce resource burden for low complexity patients.
4. Prompt use of evidence-based criteria and efficacious therapy to product better outcomes at lower cost.
Read the full report here.