Patient-Centered Medical Home Collaborative

ACHP member health plans have joined together to form a Patient-Centered Medical Home Collaborative. Working and learning together, the 15 member organizations that form the Collaborative are implementing medical homes whose goals have been shaped by the Institute for Healthcare Improvement's Triple Aim and ACHP's internal metrics.

IHI Triple Aim:

• Improving the health of populations
• Improving the experience of care
• Reducing per capita costs of care

ACHP Collaborative:

• Improved clinical outcomes
• Greater satisfaction among consumers/patients
• Lower cost trend

ACHP health plans are pushing the boundaries

Member plans and their physician practice partners agree to the medical home criteria set out by NCQA and have adopted four additional ACHP standards:

• Plans provide support and resources to providers such as predictive modeling of patient populations and case management services that support the medical home
• Practice partners collect data on clinical outcomes, patient satisfaction, and efficiency measures and demonstrate annual improvements
• Practice partners commit to "360 degree care" coordinating inpatient and outpatient care, managing transitions across settings, and ensuring that patients receive high quality care no matter where they enter the system.
• Health plans make sure that reimbursement is aligned with meeting the objectives of the medical home.

Member plans are measuring not only the structure and processes of care, but critical outcomes including:

• Management of chronic conditions, prevention of illness through screening, and treatment of acute illness
• Cost of inpatient and outpatient care and prescription drug use
• Appropriateness of care: admissions, readmissions, and emergency room use

What distinguishes the ACHP Medical Home Collaborative?

Stability: Successful medical home models require stability in place and membership. ACHP member plans are established in their communities, engender strong loyalty, and already have close partnerships with primary care practices and other providers. One important implication: Medical homes that reflect the needs, preferences, and practice patterns of local communities.

Accountability: Not only are ACHP member plans willing to be held accountable through the measurement of outcomes, costs, and patient satisfaction, they are also investing their own revenues to get medical homes off the ground.

Shared decision-making: Being patient-centered means, among other things, implementing models that provide full information about treatment options and empower patients to share in decisions about their care.

Primary Care: ACHP member plans are investing in the future of primary care. Not only are they increasing reimbursement to primary care physicians, they are also reducing caseloads, placing nurses in practices to help manage care, and investing in electronic medical records, disease registries and clinical decision support systems.