Wiring Up Our Home

> At the 10-physician, three-office Vanguard Medical Group based in Verona, a town in northeastern New Jersey, Thomas McCarrick, M.D., has been helping to lead his colleagues through the stages of PCMH development, beginning with his office’s involvement in a pilot project two years ago with Horizon Blue Cross Blue Shield of New Jersey, which had brought 35 physician practices together, in collaboration with the New Jersey Academy of Family Physicians (the New Jersey chapter of the American Academy of Family Physicians) around diabetes care management. The physicians in two of the three offices that now comprise Vanguard (the group merged three separate practices a little over a year ago) learned a great deal through participating in the pilot, McCarrick notes, including how intensely complex report development and sharing and data-sharing between physician groups and health plans can be without robust EHR and other clinical information systems. An absolutely critical lesson learned, McCarrick says, is that “To use informatics today requires being able to interface a variety of tools and applications.” He foresees integration and interoperability of clinical information systems as a major hurdle for ongoing PCMH development.

> In New Orleans, a variety of organizations have been collaborating in order to ensure the success of the PCMH concept. Eboni Price-Haywood, M.D., M.P.H., the co-executive director of Tulane Community Health Centers (TCHC), as well as that organization’s CMO and CIO, has been involved from the start in a community-wide, PCMH-modeled, demonstration project involving New Orleans’ safety-net clinics, and which was created in the wake of Hurricane Katrina, with the goal to improve care quality for underserved populations. The TCHC organization, through that program, was incentivized to pursue NCQA PCMH recognition, and its six sites achieved NCQA recognition by early 2009. In addition, under Dr. Price-Haywood’s leadership, TCHC has been collaborating with the Crescent City Beacon Community (CCBC) Program, also based in New Orleans, on an initiative to leverage clinical IT in order to improve chronic care management for area patients. Anjum Khurshid, M.D., program director and principal investigator for the CCBC program, and Maria Ludwick, the CCBC’s chronic care management lead, have been working with nearly 50 different primary care clinics, including TCHC’s clinics, on that initiative. Price-Haywood, Khurshid, and Ludwick all agree that getting the right information to flow between clinicians at the right points in the care delivery process is vital to the success of the PCMH concept, especially as supported at the community level. Not surprisingly, they are also involved in the community-wide health information exchange to support the concept.

There are also some integrated health systems that are so large and comprehensive that they can pursue the PCMH concept across their enterprises, to strong effect. One of these is the vast 20-hospital University of Pittsburgh Medical Center (UPMC) health system, which encompasses more than 400 physician offices and outpatient locations, more than 3,200 employed physicians, and even its own provider-owned health plan (UPMC Health Plan). The folks at UPMC, both on the provider and payer side, have been pursuing multiple strategies to leverage IT to support their PCMH development. Among other tools, the folks at UPMC are leveraging the interoperability platform from the Pittsburgh-based dbMotion (in which UPMC also has a financial stake) to facilitate physicians’ instant ability to view the patient record across multiple sites and systems within the vast UPMC enterprise.

COMMON THREADS AMONG DIVERSE STRUCTURES

The healthcare leaders developing these different patient-centered medical home models are obviously working across very different organizational structures, hospital-physician relationships and arrangements, and local healthcare markets and communities. They are also moving forward across dramatically different levels of information technology development and adoption. Yet all those interviewed for this article agree that there are some universal IT elements required for success with any PCMH.

One industry expert who has a strong grasp of such elements is Joe Damore, vice president of The Implementation Collaborative, a division of the Charlotte-based Premier health alliance. Damore, who has spent more than 30 years in healthcare management, including multiple stints as a hospital CEO, is currently heading up the Premier division that is supporting alliance members’ efforts to build accountable care organizational and care management vehicles.

Damore sees five absolutely key IT foundations for medical homes. “The first,” he says, “is creating an electronic record at the hospital and in the physician practice, as a base. Then, you’ve got to build that record so that it crosses the continuum of care. And you can either do that by creating an HIE, or through an integration engine. A small number of organizations”—he cites UPMC as one of the few—“are creating their own integration engines, but most don’t have the capital to create their own,” he notes. “The third element,” Damore says, “is that you’ve got to create a population health data management engine in order to measure population health and the effectiveness of your tools,” and to be able to assess costs of care, for such chronic illnesses as diabetes and congestive heart failure.