One Patient at a Time Makes a Difference in Cincinnati

Focusing on one patient at a time, Aligning Forces for Quality (AF4Q) in Cincinnati, led by the Health Collaborative, has contributed to an increase in the rates of optimal diabetes care in publicly reporting practices by 7 percent and reduced the rates of self-reported smoking in publicly reporting practices by 5 percent in its region. The Collaborative is a leading force in the movement toward patient-centered medical homes (PCMHs).

Stronger doctor and patient engagement, improved access, collaborative interventions, and careful management of chronic conditions are the cornerstones of PCMHs. When done right, the results are better medical outcomes, fewer serious episodes and hospitalizations, and better quality of life. All of these factors contribute toward lowering the cost of health care for patients and the communities.

In 2009, the Health Collaborative launched the local push toward PCMHs by recruiting 11 practices to a two-year pilot group. The intent of the pilot was to provide structured assistance to a targeted number of internal medicine and family medicine practices. The practices completed training and went on to receive PCMH recognition from the National Committee for Quality Assurance (NCQA). The idea for a co-pilot program emerged when PCMH leadership recognized it would be impossible to accommodate all of the interested applicants in the pilot program. Nine practices joined to participate in the co-pilot program.

Three health plans committed to partnering with the Collaborative’s PCMH efforts. Anthem Blue Cross and Blue Shield, Humana, and United Healthcare provided per member/per month care management fees for up to 10,000 lives. The fees were negotiated on practice-by-practice basis and ranged $2 to $6 per member.

The Collaborative’s activities did not stop with NCQA accreditation or designation. The practices prioritized a full range of cultural change activities necessary for the sustained functioning of the PCMH model.

“The PCMH efforts are creating buzz in the Cincinnati community. Patients can have a hard time understanding what the new model means and how it relates to them. We’ve hired an outreach coach and higher-level RNs as coordinators. With the collaborative effort, patients are starting to see that I need to be their quarterback,” said Dr. Paula LaFranconi, internist with PCMH pilot participant Group Health TriHealth Physician Partners.

An innovative aspect of the Collaborative’s PCMH pilots was the involvement of TransforMED, a subsidiary of American Academy of Family Physicians. The organization helped the Collaborative organize full-day learning sessions and host monthly check-up calls. Practices also were provided with a subscription to the American College of Physicians Medical Home Builder website. This site provides a broad range of information related to the PCMH concept.

After successful results from the pilot programs, the Collaborative furthered its PCMH efforts with a cohort of 18 practices. The participants of the cohort will attend six learning sessions, receive assistance and guidance from practice coaches, and report monthly quality and cost data.

“As we start to work with conditions from the Affordable Care Act, the PCMH model will continue to receive increased interest from consumers, physicians, payers, and patient advocacy groups. Patient experiences with our current health care system need drastic improvement, and we are starting with one patient at a time,” said Nancy Strassel, Project Director of AF4Q in Cincinnati.