Robert Graham, MD
Chair, Alliance for
Health Care Reform
and Professor, UC College of Medicine

This month's Progress Report provides an update on Cincinnati Aligning Forces for Quality's (AF4Q) Patient-Centered Medical Home program. I thank Dr. Robert Graham, chair of the Alliance for Health Care Reform and professor at the University of Cincinnati College of Medicine, for providing this report.
- Craig Brammer, Director, Cincinnati AF4Q

Medical care in the United States has become an increasingly fragmented, patient-driven affair which is more responsive to patients' acute needs and complaints than it is supportive of good health. Chronically ill patients may see several specialists who are not in communication with one another. No one oversees the big picture - patients often don't receive all the care they need, and some are overtreated or treated incorrectly.

Research has shown that a system like ours costs more and produces poorer outcomes than other systems. The United States spends significantly more on health care than any other country, yet is ranked 37th in the world for quality of health care by the World Health Organization.

Patient-Centered Medical Home

Recent attempts to rein in costs and improve quality have had varied success, but one model shows much promise for revolutionizing our health care system and has become a key component of the efforts of a number of groups in the United States to "transform" family medicine and internal medicine practices.

The Patient-Centered Medical Home (PCMH) model puts responsibility for coordinating care in the hands of a primary care physician who takes the time to develop a relationship with each patient. This physician makes arrangements for care by specialists and communicates with them so that patients receive integrated care that is tailored to their needs. With a focus on disease prevention and maintenance of good health, the PCMH model has a proven track record for improving patient outcomes while reducing overall health care cost. View an introductory video on PCMH.

Originally proposed in 1967 by the American Academy of Pediatrics, the PCMH model now has the backing of the American College of Physicians, the American Academy of Family Physicians and the American Osteopathic Association. These four bodies came together in 2007 to issue a statement of the Joint Principles of the Patient-Centered Medical Home which describes a team approach to health care with a whole-person orientation and a focus on quality and safety.

Built into the model are provisions for a payment structure that rewards communication with patients and specialists and the use of technology to drive evidence-based care. A growing body of research is demonstrating the effectiveness of this model in producing better patient outcomes and reducing use of hospital and emergency facilities and care-related costs.

PCMH Tested in Cincinnati

Cincinnati AF4Q is bringing this groundbreaking model to our region in a pilot program that will involve 12 to 15 primary care practices and more than 40,000 covered lives in 2010 and 2011. Three of Cincinnati's major health care insurers - Anthem, Humana and UnitedHealthcare - have been involved in designing the pilot and will reimburse participating practices by an agreed-upon, performance-based formula. At the conclusion of the pilot program, its effectiveness will be evaluated and plans will be developed for extending the PCMH model beyond the pilot group.

June 2008 - July 2009: An AF4Q workgroup including health plan representatives, employers and providers worked together in 2008 to review Medical Homes in other communities and evaluate how to apply the model to the unique situation in our region. Plans for the pilot were established, and Meredith Rosenthal, PhD, of the Harvard School of Public Health has been retained to evaluate practice data generated during the pilot. Her work will be supported by the Commonwealth Fund, a private foundation working toward improvements in quality and efficiency.

In 2009 the workgroup began the process of recruiting the practices that will participate in the pilot. Interested practices are currently applying to be included in the study, and those accepted will be notified at the end of July. Those practices not chosen for the pilot will still have the opportunity to pursue PCMH status with support and resources from AF4Q. They have the option to be involved in periodic meetings of the participating practices and to attend informational webinars.

September 2009 - August 2011: Participating practices will apply to the National Committee for Quality Assurance (NCQA) for PCMH certification by Nov. 1, and must be certified at Level One to continue in the pilot. They will begin to submit clinical data to AF4Q and Dr. Rosenthal to monitor progress and test the effectiveness of the model. Throughout the course of the pilot, the practices will continue to work toward Level Three certification.

Data from participating health plans will be submitted to Dr. Rosenthal, who will conduct a detailed analysis of pilot results to be published at the conclusion of the program. The PCMH workgroup will then work with stakeholders to determine whether and how to spread the model beyond the pilot group.

I am personally excited to see this innovative model for comprehensive health care being piloted in our region. As the nation looks to improve its primary care infrastructure, Cincinnati is viewed as a leader in bringing multiple stakeholders together to test these ideas that offer us an excellent chance of making a real difference in the lives of real people.

Sincerely, Robert Graham, MD Chair, Alliance for Health Care Reform and Professor, UC College of Medicine