Disruptive Innovators: Medical Home Run

In the early days of the latest incarnation of the patient-centered medical home, William Warning II, MD, the program director of a family medicine residency program, recognized an opportunity, and he wasn’t going to sit back and let it pass him – or his program – by.
“If you look at history, usually the training programs are the last ones to come along. Someone else figures it out and we’re kind of big and we’re clunky. We have a lot of regulations. A lot of us are institutionalized – big-time ivory tower institutionalized,” Warning said. “We’re kind of the last ones to get it. I fight that. I don’t believe in that.”
And that’s how, in 2008, Warning’s family medicine residency program at Crozer-Keystone Health System in Philadelphia became one of the first PCMH family medicine residency programs in the country. In 2009, the program achieved Level 3 PCMH recognition by the National Committee for Quality Assurance.
“We, as educators of the future workforce, should be on the cutting edge and be the first innovators to try these new products, as opposed to waiting until everyone else figures it out and comes along for the ride…” Warning said.
As it turns out, Crozer-Keystone’s PCMH family residency program has become a big draw to medical students. Warning said applicants are up by about 50 percent compared to three years ago, just after the program began.
Carmine DiMartino, a current resident in the PCMH family medicine residency at Crozer-Keystone, is well aware that the future of medicine is team based, and knows his PCMH training gives him a competitive edge.
“This is where all practices are going. In order to help meet the standards of care and delivering the best patient care, you need to hit all these guidelines…” he said. “If you’re able to, as a physician, help lead the team in accomplishing all that, it’s definitely a skill that’s sought after.”
Much like the heart of the PCMH model, Warning needed a team to make his PCMH-based residency program work. That’s where Independence Blue Cross (IBC) came in.
Like Warning, IBC, one of the largest health insurers in the Philadelphia area, saw an opportunity in the PCMH model.
By partnering with Crozer-Keystone, and other providers in the area, IBC could enhance the value of primary care in the eyes of city dwellers who frequently use emergency rooms as their main source of basic healthcare, said Richard Snyder, MD, IBC’s chief medical officer.
To support the transformation of residency and non-residency practices from traditional fee-for-service models to the PCMH model, IBC provided IT tools and money, and shares data so practices can engage in population management and practice improvement.
“When (physicians) chose primary care, they envisioned a world where they could treat patients, provide access to them, coordinate their care and teach them how to manage their illness, but the way that care delivery in a fee-for-service world is arranged it just does not permit for that to happen,” Snyder said.
To allow for the PCMH model to thrive, IBC gives physicians the opportunity to earn more for providing high quality, lower cost care. “What we’ve done is provided the opportunity, including to residency practices, to earn 220 percent of base pay,” he said. “That provides enough reimbursement and enough potential reimbursement that it attracts physicians to this.”
So far, it’s attracted enough doctors into the PCMH practice model that as much as 37 percent of IBC’s members are now getting their care in PCMH practices, Snyder said.
Importantly, both the PCMH practices and the PCMH residency programs are saving money, Snyder said. Snyder couldn’t provide specific numbers because that information will be released in four soon-to-be-published peer reviewed studies. He did acknowledge that the study results showed a statistically significant cost reduction in total cost of care for chronically ill patients and even more of a reduction in total cost of care for diabetic patients.
Enhancing primary care in the Philadelphia area by supporting PCMH residency practices and non-residency practices is not the only reason IBC partnered with Crozer-Keystone and others, Snyder noted. By supporting the PCMH model, IBC is looking ahead to a time when patients will buy their insurance on exchanges.
“When they do (shop in the exchanges) it’s going to be a Travelocity kind of experience and it’s going to be hard to know what you ought to pick to meet your needs,” Snyder said. “Hopefully, we can provide the kind of brand recognition and experience before they enter that environment that will bring them back to us and help keep them engaged with the medical homes.”