Unique Patient Care Model Seeks to Alleviate Primary Care Crisis

The U.S. healthcare system is facing a problematic shortage of primary care physicians.  Many doctors and medical students, attracted by the significantly higher pay and better work hours, are instead becoming specialists. It has been estimated that the U.S. could face a shortage of 40,000 PCPs in the next decade. At the same time, 32 million Americans will now be covered under the healthcare reform bill, and they’re going to need primary care doctors.

Where no incentive exists, one must be created. The concept of a patient-centered medical home (PCMH) may hold the key to luring PCPs back to the profession while providing more effective patient care. A PCMH envisions healthcare as a collaborative effort between payers, patients, and providers, with the primary care physician at the center. The PCP takes a holistic approach to the patient’s health, coordinating with specialists and using electronic medical records to ensure that the patient is receiving the best possible care. Rather than dole out payment based on the number of prescriptions and procedures dispensed, a PCHM rewards physicians based on outcomes. The PCMH model took a big step forward in 2006, when computer company IBM co-founded the Patient-Centered Primary Care Collaborative. To date, over 500 large employers, healthcare providers, insurance companies, and organizations belong to the PCPCC.

One company helping to implement the PCMH concept is MEDecision, a provider of collaborative healthcare solutions. The Wayne, Penn.-based company hosted a webinar on Wednesday afternoon entitled “The Patient Centered Medical Home and Evolving Care Management Processes.” Dr. Andrew Schuyler and Matt Adamson of MEDecision discussed how the company uses analytics to identify patients who have chronic conditions or gaps in their care, and provide actionable information to aid physicians in developing a care plan. The company’s Nexalign service can send mobile alerts to physicians and deliver point-of-care treatment updates. Another service, InFrame, can pull together a patient’s records from multiple systems or locations. Patients may log in to a secure web portal and view their information for better control over their care. By combining these services, MEDecision seeks to reduce ER visits, provide improved patient care, reduce inefficiencies, and improve reimbursement to PCPs.

Of course, such ambitious goals need hard evidence to back them up. MEDecision is currently being tested with a major insurance provider in one of America’s unhealthiest states. Dr. Joe Nicholson, Vice President and Chief Medical Officer for Blue Cross and Blue Shield of Oklahoma, spoke about the pilot program that his company has implemented with the aid of MEDecision. The program is designed to identify gaps in patient care and reimburse doctors for closing them. According to Nicholson, many of the gaps arise from patient noncompliance and a lack of information at the doctors’ fingertips. MEDecision’s software would make patient data available on a common platform to boost administrative efficiency. Through the use of analytics, physicians could be made aware of clinical or preventative gaps in care–for example, a 53-year-old woman who hadn’t undergone a mammogram in three years. Nicholson would also like to make virtual doctor’s visits available to patients in Oklahoma, a state that faces a particularly severe shortage of PCPs. About 45 PCP doctors, servicing approximately 20,000 Blue Cross/Blue Shield patients, are participating in the soft launch of the pilot program. A full launch is expected in July.

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