AHRQ and the Medical Home: Building a Blueprint David Meyers, MD Director, AHRQ Center for Primary Care AHRQ Annual Conference September, 2010. Disclosures. The speaker has no financial or other conflicts of interest to report. Disclosures.
AHRQ and the Medical Home:Building a BlueprintDavid Meyers, MDDirector, AHRQ Center for Primary Care AHRQ Annual ConferenceSeptember, 2010
(After all, I’m a bureaucrat)
in Support of the PCMH (15 min)
Senior Researcher, MPR
Vice President, ACP
To improve the quality, safety, efficiency, and effectiveness of health care for all Americans
AHRQ recognizes that
the Nation’s primary care system
is foundational to achieving
high-quality, accessible, efficient health care for all Americans.
Quality and safety
Physician directed practice
Whole person orientation
Quality and safety
PaymentAHRQ and the Joint Principles Closely Aligned
Policy options include:
Adding explicit functionalities that directly support the PCMH model to the recently released EHR certification standards and criteria.
Adding meaningful use requirements that support the PCMH model for stages 2 and 3 of the EHR Incentive Program.
Funding the provision of technical assistance to primary care practices on PCMH transformation alongside the planned assistance on health IT adoption through Regional Extension Centers (RECs) or through a Primary Care Extension Service.
How can policymakers ensure that the PCMH is responsive to and reflective of the goals, preferences, and needs of patients?
By promoting the involvement of patients and families in the medical home at three levels:
Policy options include:
Both sections authorized without the appropriation of funds
Please visit and help us spread the word
September 27, 2010
AHRQ Annual Conference
Debbie Peikes, Ph.D.
Payers/insurers: Will the PCMH reduce costs enough to cover the payments to providers and in-kind supports?
Practices: Transformation requires staffing, IT changes, time, and $. Will these translate into more satisfaction, $?
Patients: Will experience and outcomes improve? Will premiums fall?
Vendors: Will this movement exist in 5 years?
Model isn’t actually implemented fully
Model is implemented, but does not work
Decreases satisfaction of patients
Decreases provider satisfaction
Simply proceeding without evidence may divert resources from other primary care transformations that would work
Document whether the PCMH model was implemented
Identify barriers and facilitators to being a medical home
Assess effectiveness to justify investment
Measure performance to reward providers differentially
Guide replication of successful features
Efforts needed to reach MH criteria (time, internal and external resources, $)
Limits, potential of health IT
Ease of changing staffing and workflows
Resources required from outside the practice
Best practices and models
For patient outreach, recruitment, and engagement
For chronic care, etc.
Disease-specific and population-based quality of care measures
Process: Evidence-based care (e.g., foot exams for patients with diabetes)
Outcomes: Ambulatory-care sensitive complications
Coordination of care (harder to measure)
If providers are worse off, they won’t want to do this
Service use and cost
If this isn’t cost neutral or cheaper, payers won’t play
Well designed studies are not testing the full medical home (e.g., Guided Care, GRACE), or do so in a closed system (Group Health), or don’t have access to cost data (NDP)
Many studies are poorly designed, or do not report methods (e.g., North Carolina)
Many planned studies are too short, have not represented the counterfactual, do not address clustering, and are underpowered
Standardized measures of different medical home models to test variants
Fair comparison groups-similar before the intervention
At the practice level
At the patient level
Consider random assignment, staggered rollouts
Information on best claims-based approaches to attribute patients to their practices
Need time to allow transformation to happen
Most evaluations are using only 1.5–2 years
Statistical techniques that account for clustering at the practice level
Not doing so will give false positives
Large sample sizes
We may erroneously find no effect because practices don’t have enough time to change or there isn’t enough sample to detect change
Costs vary so much it is difficult to separate intervention effects from random noise (this affects P4P too!)
Data repositories and guidelines for cross-walking all payer claims data
Well defined intermediate and final outcome measures that are comparable across studies
Grant funding from Pfizer and UnitedHealthGroup to support program development (ACP Medical Home Builder)
Quality improvement programs sponsored by pharmaceutical companies as part of ACPNet & ACP Closing the Gap
"I put a dollar in a change machine. Nothing changed." Needs of Researchers— George Carlin
Patient-Centered Medical Home
Health Care Home
Person-Centered Health Care Home
Certified EHR Technology
Accountable Care Act (PPACA, ACA)
Maintenance of Certification
Physician Quality Reporting Initiative – PQRI
E-prescribing Incentive Program
Drawing by: M.C. Escher
Honestly, I have given up on all my professional organizations - they simply cannot or will not understand the point of view of the solo practitioner.
Haven't we given up enough of our autonomy? Aren't enough non-physicians in control of our destiny as it is?
I agree that there are a lot of issues in medicine today (billing, paperwork, bureaucracy to name only a few). However, if those issues render you cold and uncaring, my friend, I strongly suggest you find another profession.
…the complex requirements of "meaningful use" mainly serve the EHR companies (who, not surprisingly, had a hand in developing the rule).