Measuring the success of a patient-centered medical home

By John Khoury | Accountable Delivery System Institute

A patient-centered medical home, or PCMH, is a collaborative, team-based model of care led by a personal physician who provides continuous and coordinated care — including preventive services, treatment of acute and chronic illnesses, and end-of-life care — throughout a patient’s lifetime to maximize health outcomes in a culturally and linguistically appropriate manner. The PCMH has recently gained national attention as a way to reengineer the care-delivery process to improve quality and reduce the cost of care. Although preliminary studies suggest the PCMH can result in improved population health, enhanced patient experience, and reduced/controlled per capita cost of care, the lack of standardized measurements across PCMHs impedes the ability to compare them to each other, as well as to other payment and care delivery models, such as accountable care organizations and Medicare Advantage plans.
The Commonwealth Fund created the PCMH Evaluators’ Collaborative in 2008 to align methods, share best practices, and exchange information to improve PCMH evaluation designs. Through five workgroups, the Collaborative recommends a set of standardized criteria to evaluate all PCMHs. The workgroups include:

  • Physician and staff experience
  • Clinical quality
  • Cost and efficiency
  • Patient experience
  • Process and implementation metrics

After internal review and consultation with outside experts, such as the National Committee for Quality Assurance and the Centers for Medicare and Medicaid Services, the Collaborative presented a webinar this week on its recommended cost and utilization measures (see Table 1) and clinical quality measures (see Table 2) to evaluate a PCMH.

Measuring the success of a patient-centered medical home

Measuring the success of a patient-centered medical homeThe Collaborative recommends that PCMH evaluations use standardized, validated, and nationally endorsed measures whenever possible.  For clinical quality, they advise evaluators to select measures from each of the following areas of primary care: preventive care, chronic disease management, acute care, overuse, and safety. Additionally, the Collaborative recommends gathering all data through a validated collection method that includes a combination of claims, electronic health record, survey, and medical record review. It also recommends that all medical practices within a PCMH use a consistent data collection practice.

In addition to the core recommended measures, the Collaborative has provided supplemental measures for PCMHs to consider based on their specific goals and opportunities (see Table 3).

Measuring the success of a patient-centered medical homeAs more PCMHs are created, the need for guidance and standardization is great. The PCMH Evaluators’ Collaborative’s efforts on the standardization of data collection, measures, and methodologies is a much-needed effort that will enable PCMH comparison, lead to further PCMH collaboration, and ultimately create future enhancements in the quality and cost of health care.

About John Khoury

Director, Clinical Decision Support, Essence Healthcare - John Khoury is an experienced pharmacist, with more than 15 years serving in multiple clinical and business roles at Missouri Baptist Medical Center, part of the BJC HealthCare system. He was Pharmacist in Charge of Missouri Baptist Medical Center at Sunset Hills and was responsible for the Cancer Center, Operating Room, and IV Room pharmacies. He also is a Lean Six Sigma Yellow belt with extensive experience, running more than 30 kaizen events throughout BJC HealthCare and as a freelance consultant. As Director of Clinical Decision Support at EGHC, Dr. Khoury is responsible for clinical content across the company’s lines of business and is a product development owner for Lumeris.

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