To date, just over 4,900 group practices--encompassing 23,000 physicians, physician assistants and advanced nurse practitioners--have attained NCQA recognition as a medical home (the group also recognizes excellence of care in specific disease states). The recognition is a critical first step in participating in payer incentive programs targeting primary care practices. It’s an I.T.-intensive care delivery model with the potential to reduce cost and better coordinate care by having primary care physicians be the quarterback of a patient’s treatment.
Attaining NCQA medical home status--a prerequisite for some payer incentive programs--is a time-consuming experience just to apply, let alone changing the underlying operation. Family Medical Associates of Raleigh (N.C.) found that out when it received NCQA Level III recognition in 2010. “We had already attained NCQA recognition for our diabetic and hypertension care, and we wanted to add to it,” says Janet Spangler, practice administrator at the 9-provider group (which has already attested for Stage 1 meaningful use). “In North Carolina, Blue Cross Blue Shield has tied medical home status to a new quality program, so it was also another opportunity for increased reimbursement,” she says. “You have to maintain NCQA recognition, maintain certain e-prescribing percentages, and do follow-up with patients. You must precept medical students and maintain various quality metrics. It builds on the NCQA requirements.”
Spangler says the practice’s next foray is learning how to play in the world of accountable care organizations. The group is in two ACO efforts, with its local Blues plan and Cigna. The programs are payer-initiated. “The medical home has nothing to do with trying to cap costs,” Spangler says. “It is great we are doing the extra services (required of medical homes). But the medical home incentive payment doesn’t touch the added cost. It is the same with meaningful use. It is nice, but it is a fraction of what you spend on IT and staff to do it.”
Spangler says its ACO efforts will be wrapped around clinical quality measures. “The payers want us to build better communications between family practice and specialists. Our goal is to be cost effective in the way we are managing patients.”
The cover story of HDM’s January issue will focus on the technology and change management experiences of physicians and their staffs pursuing medical home status.
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