Building the Patient-Centered Medical Home in Pittsburgh

Well, there’s a lot of controversy about these things: the New England Journal of Medicine had two counter-opposed studies published this week. [See one guest editorial here: http://www.nejm.org/doi/full/10.1056/NEJMp1201268 ]
 I personally think the most important thing is getting back in touch with your primary care physician within a pretty quick period of time. We did a demonstration project on this with congestive heart failure, a little pilot we did within our community practice, that ran for six months. I expect that we’ll achieve even better results over the course of a year.

And if patients know they’re being cared for, they’ll be more participatory, right?

Yes, you’ve got to get patients engaged.

What are the IT strategic implications in all this, from your perspective?

There are a lot of IT components were built to help coordinate this. Anne Docimo, M.D. [chief medical officer at UPMC Health Plan] helped put together all the back-office IT components of this, so that when Nadine needs something, it’s very easy; she puts it into a work cue. Basically, if someone needs depression care, she knows where to look.

Is it in the EHR?

Well, the health plan has developed their own back-office functionality, so there is documentation that takes place in that electronic record; and our care managers can use our EHR as well, as a communication tool. The key is that you don’t have someone sitting in a telephonic situation, in a call center, who has no connection with the doctors. This way, Nadine can say, ‘Let me talk to Dr. Solano about that.’ It’s a so much better thing to have someone right here in the office with the resources. The person sitting in a call center in Colorado is a nice thing, but this is far more effective. But it takes resource development. The Geisinger Health System just published something in the American Journal of Managed Care in which they haven’t been able to document direct ROI. But I’ve got to believe that the care quality is better. And we have level three NCQA recognition. And it’s so much better having everyone feel really connected.

Do you have any explicit advice for CIOs and CMIOs in facilitating these kinds of advances?

It’s a long journey, and there are a lot of dead ends. We’ve done a lot of things that don’t always pan out. But I think that, first of all, your efforts have to be integrated. And I’d love to see the health plan integrate with me, but legally, that’s a challenge right now. Our lawmakers should know that we would be better off if we could receive information directly from payers, because right now, there’s a lot of information we can’t get. So we’re going to have to become a lot more transparent in that way.

It will take some time and development, I think.

Let me tell you a great story: we have ranking reports by practice and by doctor, by key metrics, across a number of dimensions for patient care. And we took our top and bottom 25 doctors, and looked at cost and efficiency metrics and the differences between the top and bottom tier guys; and disappointingly, the top-tier guys cost more money and used more resources. That was disappointing, but to do good preventive care costs more money, and to do good chronic care costs more money. In my mind, I’m optimistic over the long run that providing better care will ultimately lead to better outcomes and results. I look at our practice of nine providers, and our average daily inpatient census is two to four patients, which is pretty good, because we have nine doctors, and so that’s a pretty low census. But if you keep people alive longer, they’ll ultimately need more care.

And this is a collaborative effort between and among the physicians, the medical management team, the IT team, and the business team. We all work together—this is truly a team effort. So I would add, you can’t silo yourself—and that’s such a cliché to say, but this is the ultimate anti-silo experience.