Advertisement

Provider Experiences with a Payer-Based PCMH Program

  • Gilbert GimmEmail author
  • Debora G. Goldberg
  • Nouran Ghanem
  • Sahar Haghighat
  • Jay Want
  • Dan Hough
  • Len M. Nichols
Original Research

Abstract

Background

The patient-centered medical home (PCMH) is an enhanced primary care model that aims to improve quality of care. Over the past several years, the PCMH model has been adopted by Medicare and private payers, which offer financial resources and technical assistance to participating practices. However, few studies have examined provider experiences and perspectives on the adoption of payer-based PCMH models in different practice settings.

Objective

The goal of this qualitative study was to analyze how providers experienced specific elements of a payer-based PCMH model and identify cross-cutting themes that can be applied to other payer-based PCMH initiatives.

Design

Observational qualitative study.

Participants

A total of 65 individuals (which includes 57 primary care physicians) participated in focus group sessions. Telephone interviews were conducted with an additional 14 physicians and 2 practice administrators.

Approach

Interviews and focus groups were recorded after obtaining the informed consent of participants. Written transcripts from the recordings were then imported into NVivo 11 for subsequent coding and qualitative analysis of themes.

Key Results

We found that nurse care coordinators (NCCs) were the single most valuable and visible program element. Individual care plans served as effective tools of communication between the NCC and physician on patient care management goals and issues. The online data portal was viewed as the least valuable element. With regard to cross-cutting themes, some providers expressed a strained relationship with CareFirst due to communication challenges, a lack of trust, and differing priorities in selecting patients for care plans.

Conclusion

Nurse care coordinators and the targeted use of individualized care plans are essential components in a payer-based PCMH program. Improving communication and trust in data reports are critical for effective implementation. Future research should examine provider experiences in other payer-based PCMH programs to see how interactions with payers affect program implementation.

KEY WORDS

provider experiences qualitative patient-centered medical home 

Notes

Acknowledgments

We would like to thank Alan newman Research for their contributions in the production and gathering of written transcripts for this study.

Financial Disclosure

This program evaluation study was supported by a research grant from CareFirst BlueCross BlueShield of Maryland.

Compliance with Ethical Standards

All research protocols, focus group moderator guides and data collecition instruments were approved by the GMU Instituional Review Board. Each participant gave informed consent for the interview and audio-recording.

Conflict of Interest

Dr. Want is an employee of the Peterson Center on Healthcare and Want Healthcare LLC. Mr. Hough is an employee of Alan Newman Research. Dr. Nichols discloses receiving honoraria from the following organizations: WC Research, Inc.; Navigant Consulting; Institute for International Research; Kaufman and Conoles, P.C.; Conent, Inc.; and the Center for Corporate Innovation. All other authors declare they have no conflicts of interest.

Supplementary material

11606_2019_5005_MOESM1_ESM.docx (20 kb)
ESM 1 (DOCX 19 kb)

References

  1. 1.
    Patient-Centered Primary Care Collaborative (PCPCC). Joint principles of the patient-centered medical home, 2007. Available at: http://www.pcpcc.org/about/medical-home. Accessed on February 25, 2019.
  2. 2.
    O’Malley AS, Gourvetich R, Draper K, Bond A, Tirodkar MA. Overcoming challenges to teamwork in patient-centered medical homes: a qualitative study. J Gen Intern Med. 2015; 30(2): 183–192.CrossRefGoogle Scholar
  3. 3.
    Friedman A, Howard J, Shaw E, Cohen D, Shahidi L, Ferrante J. Facilitator and barriers to care coordination in patient-centered medical homes (PCMHs) from coordinators’ perspectives. J Am Board Fam Med. 2016; 29(1): 90–101.CrossRefGoogle Scholar
  4. 4.
    Geonnotti K, Taylor E, Peikes D, et al. Engaging Primary Care Practices in Quality Improvement: Strategies for Practice Facilitators. AHRQ Publication No. 15–0015-EF. Rockville, MD: Agency for Healthcare Research and Quality: 2015.Google Scholar
  5. 5.
    Alexander JA, Markovitz AR, Paustian ML, et al. Implementation of patient-centered medical homes in adult primary care practices. Med Care Res Rev. 2015; 72(4): 438–467.CrossRefGoogle Scholar
  6. 6.
    Gimm G, Want J, Hough D, Polk T, Rodan M, Nichols LM. Medical home implementation in small primary care practices: provider perspectives. J Am Board Fam Med. 2016; 29(1): 90–101.CrossRefGoogle Scholar
  7. 7.
    Goldberg DG, Kuzel AJ. Elements of the patient-centered medical home in family practices in Virginia, Ann Fam Med. 2009; 7(4): 301–308.CrossRefGoogle Scholar
  8. 8.
    Rittenhouse D, Casalino L, Shortell S, et al. Small and medium-size physician practices use few patient-centered medical home processes. Health Aff (Millwood). 2011; 30(8): 1575–1584.CrossRefGoogle Scholar
  9. 9.
    Peikes D, Zutshi A, Genevro JL, Parchman ML, Meyers DS. Early evaluations of the medical home: building on a promising start. Am J Manag Care. 2012; 18(2):105–116.Google Scholar
  10. 10.
    Friedberg MW, Schneider EC, Rosenthal MB, Volpp KG, Werner RM. Association between participation in a multipayer medical home intervention and changes in quality, utilization, and costs of care. JAMA. 2014; 311(8): 815–825.CrossRefGoogle Scholar
  11. 11.
    Lemak CH, Nahra TA, Cohen GR, et al. Michigan’s fee-for-value physician incentive program reduces spending and improves quality in primary care. Health Aff (Millwood). 2015; 34(4): 645–652.CrossRefGoogle Scholar
  12. 12.
    Dale SB, Ghosh A, Peikes DN et al. Two-year costs and quality in the comprehensive primary care initiative. N Engl J Med. 2016; 374(24): 2345–2356.CrossRefGoogle Scholar
  13. 13.
    Cuellar A, Helmchen LA, Gimm G, et al. The Carefirst patient-centered medical home program: cost and utilization effects in its first three years. J Gen Intern Med. 2016; 31(11):1382–1388CrossRefGoogle Scholar
  14. 14.
    Afendulis CC, Hatfield LA, Landon BE, et al. Early impact of Carefirst’s patient-centered medical home with strong financial incentives. Health Aff (Millwood). 2017; 36(3):468–475.CrossRefGoogle Scholar
  15. 15.
    Marsteller JA, Hsu Y-J, Gill C, et al.Maryland multipayor patient-centered medical home program: a 4-year quasi-experimental evaluation of quality, utilization, patient satisfaction, and provider perceptions. Med Care. 2018; 56(4):308–320.Google Scholar
  16. 16.
    CareFirst Blue Cross Blue Shield. 2017 Program Guidelines and Description for CareFirst Patient-Centered Medical Home Program (PCMH). Available at: https://www.provider.carefirst.com/carefirst-resources/provider/pdf/pcmh-program-description-guidelines.pdf. Accessed on February 25, 2019.
  17. 17.
    Patton M. Qualitative evaluation and research methods. Beverly Hills, CA: Sage Publications; 1990:169–186.Google Scholar
  18. 18.
    Lincoln YS, Guba EG. Naturalistic Inquiry. Newbury Park, CA: Sage Publications; 1985:301–315.Google Scholar
  19. 19.
    Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics. 1977; 33: 159–174.CrossRefGoogle Scholar
  20. 20.
    Richardson JE, Kern LM, Silver M, Jung HY, Kaushal R. Physician satisfaction in practices that transformed into patient-centered medical homes: a statewide study in New York. Am J Med Qual. 2016; 31(4): 331–336.CrossRefGoogle Scholar
  21. 21.
    Alidina S, Rosenthal MB, Schneider EC, Singer SJ, Friedberg MW. Practice environments and job satisfaction in patient-centered medical homes. Ann Fam Med. 2014; 12(4): 331–337.CrossRefGoogle Scholar
  22. 22.
    West CP, Dyrbye LN, Rabatin JT, et al. Intervention to promote physician well-being, job satisfaction, and professionalism: a randomized clinical trial. JAMA Intern Med. 2014; 174(4):527–533CrossRefGoogle Scholar
  23. 23.
    Shoemaker SJ, McNellis RJ, DeWalt DA. The capacity of primary care for improving evidence-based care: early findings from AHRQ’s EvidenceNOW. Ann Fam Med. 2018; 16 (Suppl. 1): S2-S4.CrossRefGoogle Scholar
  24. 24.
    Wilensky GR. Will MACRA improve physician reimbursement? N Engl J Med. 2018; 378 (14):1269–1271CrossRefGoogle Scholar
  25. 25.
    Peterson GG, Geonnotti KL, Hula L, et al. Association between extending Carefirst’s medical home program to Medicare patients and quality of care, utilization, and spending. JAMA Intern Med. 2017;177(9):1334–1342CrossRefGoogle Scholar

Copyright information

© Society of General Internal Medicine 2019

Authors and Affiliations

  • Gilbert Gimm
    • 1
    Email author
  • Debora G. Goldberg
    • 2
  • Nouran Ghanem
    • 2
  • Sahar Haghighat
    • 2
  • Jay Want
    • 3
  • Dan Hough
    • 4
  • Len M. Nichols
    • 2
  1. 1.Department of Health Administration and PolicyGeorge Mason UniversityFairfaxUSA
  2. 2.George Mason UniversityFairfaxUSA
  3. 3.Peterson Center on HealthcareNew YorkUSA
  4. 4.Alan Newman ResearchRichmondUSA

Personalised recommendations