Medical home set to move forward.

WASHINGTON -- Medical home advocates hope a new set of metrics will help primary care physicians move closer to implementing this model of care.

The metrics assess how patient centered an office-based practice is and how well the practice's care delivery system works. Scores on the tool correlate with enhanced clinical performance and lead to voluntary designation as a patient-centered medical home, according to Dr. Greg Pawlson, executive vice president of the National Committee for Quality Assurance (NCQA).

Having a set of metrics is "a very important step on the way to ... a series of large-scale pilot demonstration projects," Dr. Pawlson said at a press briefing to unveil the tool. "Most importantly, it provides a road map for where a practice needs to go from where it is now to where it needs to be as a patient-centered medical home," he said.

The American College of Physicians, the American Academy of Family Physicians, the American Academy of Pediatrics, and the American Osteopathic Association worked with NCQA on the development of Physician Practice Connections. These four primary care groups have endorsed the tool as a way for practices to qualify as medical homes in pilot demonstration projects slated to begin as early as 2008.

"I think of medical home as the standard of care for primary care. That's the type of care that we all want to provide," said Dr. Vera F. Tait, associate executive director of the American Academy of Pediatrics.

Not everyone is clear on what exactly a medical home is, noted Dr. James King, president of the American Academy of Family Physicians. "A lot of people [are] starting to use the phrase [medical home], and they're talking about things that have nothing to do with what we're talking about here," Dr. King said. The ability to identify the components of a medical home and to measure how these components affect patient health and costs is an important step toward widespread use of the concept in physicians' offices.

According to NCQA and its primary care partners, the four core components of a medical home--self-management support, decision support, delivery system design, and clinical information systems--are aimed at producing collaboration between informed and motivated patients and a prepared and proactive practice team.

"This is what we think it would take to be a medical home," Dr. Pawlson said. According to the Physician Practice Connection concept, a medical home practice should be able to:

* Track patients via care management reminders, referrals, and patient care goals and create and update patient registries.

* Employ easy access and scheduling.

* Provide care management in person, by telephone, and by e-mail.

* Prescribe electronically to improve efficiency and to check for prescription safety.

* Capture a patient's test results history and follow up on those results.

* Follow up on referral results.

* Measure performance and provide feedback and reporting.

Although the metrics take a significant step toward creating a medical home system, the reimbursement issue is in the forefront of many physicians' minds.

"We need to find ways to improve reimbursement.... It's a very urgent issue," said Dr. David C. Dale, president of the American College of Physicians. "It's the lack of funds to pay the practice or to attract people to go into this level of practice which is going to be our Waterloo."

To that end, a blended payment has been advanced as a way to pay physicians for the type of work required in the medical home model. This payment model is intended to recognize care coordination, office visits, and performance.

"This is something new. This is not tweaking the old system," said Rosemarie Sweeney, vice president for public policy and practice support for the American Academy of Family Physicians. "Care coordination would be a monthly fee that is paid in recognition of all of that additional coordination work that goes into keeping patients healthy," he said.

Payment for office visits would continue to be made through the current fee-for-service system.

In addition, "there is a performance-based component to encourage higher-quality care and to reward that quality of care," she said.

A number of third-party payers already are lining up to initiate demonstration projects using the patient-centered medical home metrics and some form of blended payment. WellPoint Inc., the BlueCross BlueShield Association, United HealthCare Services Inc., and others have planning underway for medical home demonstration projects, some of which may start as early as 2008.

In addition, some large employers--IBM, Walgreen's, and others--are beginning to show interest in the medical home model. When IBM looked into the health care experiences of its workers, the company found that "employees who use a patient-centered primary care approach enjoyed better health at lower costs," said Dr. Paul Grundy, director of health care technology and strategic initiatives at IBM.

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BY KERRI WACHTER

Senior Writer