Across its 20 hospitals and more than 400 physician and outpatient offices, the University of Pittsburgh Medical Center health system is moving forward on several initiatives aimed at improving the quality of care, integrating its delivery system, and reforming payment structures.
Considered a leading U.S. health system, UPMC’s patient-centered medical home program – which is tied to other initiatives like payment and delivery system reform – is showing promising outcomes.
As part of an integrated healthcare delivery system, UPMC Health Plan partners with UPMC and community network providers to improve clinical outcomes. Founded on the principles of the patient-centered medical home and the Wagner Chronic Care Model, UPMC Health Plan uses a care coordination team and practice-based care managers, which enable physicians to better deliver continuous, accessible, high quality, patient-oriented primary care.
Dr. Stephen Perkins, vice president of Medical Affairs for UPMC Health Plan, oversees UPMC Health Plan Community Health initiatives, including the patient-centered medical home. While Perkins says physicians were at first skeptical of the medical home idea, direct engagement between patients and providers has had a significant impact on members’ quality of care.
“We’ve seen a drop in the overall per member per month cost trends as compared to the rest of our patient population,” Perkins says.
In the program’s first year, the overall readmission rate for patients in medical home practices dropped 12.5 percent compared to non-medical home practices. In the second year, readmissions dropped 18.5 percent compared to regular practices.
While pharmacy costs and inpatient costs, including emergency department use, have dropped, costs in outpatient services like preventive services – such as colonoscopies, well visits and primary care visits – increased twofold, and that was before the Patient Protection and Affordable Care Act was implemented in 2010, which requires health insurers to provide certain preventive services to patients with no cost-sharing.
“You can’t drop costs completely,” Perkins says. But overall, the trend is that medical home patients generally cost much less than non-medical home patients.
The Expanded Role of Practice-Based Care Managers
Launched in 2008, UPMC Health Plan will have about one-third of its total members – or 250,000 people – enrolled in its medical home program by the end of this year. That’s up from between 8,500 and 9,000 patients when the program first started.
In its medical home model, UPMC Health Plan care managers help coordinate health services with other providers, manage health conditions, connect with community resources, manage prescriptions, lower or maintain patients’ weight, decrease stress, quit smoking, and identify safety and fall risks in the home.
In addition, UPMC Health Plan’s medical home uses electronic health records and practice-based case managers to improve care. As a liaison between the health plan and practice, the case manager provides actionable information on things like unplanned care events to the practice on a day-to-day basis.
Before the implementation of the medical home, UPMC Health Plan took a telephonic approach with case managers. But now the health plan uses telephonic case managers to provide back-up support to the practice-based case managers for a more comprehensive approach.
Perkins says that patients definitely benefit from being in the medical home program. They receive more coordinated services so there’s less confusion about their care plan, and they share in the decision-making with their physician and care team.
“The physician and the member are on a much more parallel track,” Perkins says.
To track patient satisfaction, Perkins says UPMC Health Plan has started administering patient surveys.
UPMC Health Plan’s integrated practice-based care managers are charged with making direct contact with plan members, identifying barriers to care, and educating patients about the medical home and what they should expect from being in the medical home program.
Having a patient-centered approach to care also helps cut down on the number of duplicate or potentially harmful tests and services.
“We’re managing their care in a way that they can understand the different components of what their care is,” Perkins says.
While the medical home model may deliver significant positive results, Perkins says it is not the sole answer for restructuring the U.S. healthcare.
“[The patient-centered medical home] is not all-encompassing,” Perkins says. “It’s a component that needs to move forward.”
To move forward, the medical home needs to be tailored to meet the specific needs of different populations in various geographic areas, Perkins says.