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Value-based programs

Benefits of a patient-centered medical home

The patient-centered medical home (PCMH) is a method to deliver and organize healthcare that helps to improve the patient's experience of care, improve the health of populations, and reduce or control the costs of healthcare. The PCMH model allows the primary care provider and the patient to be in the center of the healthcare system, to know what is going on and help the patient be in control of their health.

Support for practice redesign:

Practices in the PCMH program will have a Primary Care Representative to guide them through the PCMH process. Practices will have access to PCMH resources, webinars and training throughout the year. The Primary Care Representative will be available to answer questions, provide feedback or make site visits as necessary to help practices be successful.

There are two financial components to support Practices, care management fees and a performance based incentive payment. Care management fees are calculated on a per member per month (PMPM) basis for all fully insured plans and some self-insured plans. The performance based incentive (PBIP) began with the 2020 program year and is calculated on quality metrics, utilization, and patient experience of care.

Benefits of practice redesign:

  • Comprehensive care – A personal model of healthcare that includes an ongoing relationship between a patient and their primary care provider, who will help patients with their healthcare needs in all stages of life. The provider and care team know the patients and their families, and assume an ongoing responsibility of care. The care team uses a planned approach to identify needed services in order to improve the health of the population in general as well as the individual patient. The ultimate goal is to get patients healthy and keep them healthy.
  • Patient-centered care – The PCMH model is a partnership between the primary care team and the patient. Patients are presented with treatment options and the information they need in order to make an informed decision regarding their plan of care that meet their own personal goals. The PCMH will equip patients with the knowledge and tools they need to manage their conditions.
  • Coordinated care – The patient’s healthcare needs are coordinated and managed by a primary care team who will focus on improving communication across the entire healthcare system. Referrals and tests are tracked to make sure patients receive the care they need and the primary care team receives the records and test results in order to provide the best care possible. Patients are contacted after hospitalization to make sure that they receive any follow-up care needed.
  • Accessible services – Patients receive the right care, at the right time, in the right place.
  • Quality & safety – Medical homes provide care based on evidence-based guidelines to provide better quality of care, tracking outcomes and results, and continually working to improve care.

The patient-centered medical home provides better care and greater satisfaction to patients, physicians, and the healthcare team by making sure that the patient’s needs are met.