Improving Primary Care Training by Creating Patient-Centered Medical Homes via Medicaid Waiver: New York

Rationale / Objectives

The Hospital Medical Home (HMH) Demonstration program wanted to create an environment that would help train upcoming physicians in the patient medical home style of care delivery in order to improve education, patient outcomes and continuity of care. They wanted to prepare physicians for teamwork, decision-making that factors in costs, and population health management. 1 2

Project/Program Description & Major Achievements

Participating training sites transformed their care delivery system in accordance with the National Committee on Quality Assurance (NCQA) medical home requirements. Some strategies used to guide the changes were site visits, coaching calls, resident surveys, data reporting and feedback. A resources website was developed in conjunction with a portal for reporting measures and providing feedback. All of the participating sites achieved Patient Centered Medical Home (PCMH) recognition, and 75-80% of sites saw statistically significant increases in colorectal and tobacco use screening rates. 1 2

Lessons Learned

Access to secondary care increased by 7%. Communication and coordination are challenges in residency clinics, especially when staffing is limited. Resources must be allocated to ensure that notification systems and follow-up care are available to high-risk patients. The requirement for non-physician staff increased and at times had to be met using external services. Resources to sustain the changes achieved by the HMH program must be acquired through other initiatives until the cost of the changes is offset by savings. Residents themselves often innovated, with projects such as chronic disease registries and open-access scheduling. All of the sites hired a Care Manager, which allowed the residents to focus on treating patients. Residents had to acquaint themselves with standardized measurements and risk adjustments. Coaching calls were tailored to the site according to information gathered through the portal. 1 2

Further Description

The future of primary healthcare delivery is in patient-centered medical homes. Traditional resident training sites often do a poor job of care coordination and continuity, both central features of the patient-centered medical home, due to rotating residents and attendings. This can negatively impact patient care. Enhancing the training environment may require additional resources such as staff, electronic health records, and training. These are not generally part of residency programs. Funding provided by the program was used to put quality improvement projects in place that were based on the PDSA (plan do study act) cycle. When goals were met, hospitals received awards based on Medicaid volume and the number of primary care residents at the site.1 2

Major Achievements

Metric Result Detail
Colorectal screening rates Increased by 11% (p = 0.01) Increased In 80% of sites 1
Tobacco use screening and cessation counseling Increased by 16% (p= 0.01) Increased in 75% of sites 1
Access to secondary care Increased by 7% (p = 0.01) 1
Integration of physical and behavioural healthcare Increased by 33% (p = 0.01) 1
Ability to access behavioural health provider within PCP-requested time-frame 90% 1
PCMH achievement 100% of sites by October 2014 High-level 2011 PCMH recognition 2
Post-discharge follow-up within 48 hours 73% 1