Two health plan initiatives—the patient-centered medical home (PCMH) and value-based insurance design (VBID)—can lead to lower health costs and improved employee health, say experts who contend that "obvious synergies" between the two programs often go unnoticed because they are carried out separately.
The proposal was made in a report presented to a conference in Washington, DC, by authors from the National Business Coalition on Health, the Patient-Centered Care Collaborative, and the University of Michigan Center for VBID.
In recent years, the authors stated in the report, entitled "Aligning Incentives and Systems –Promoting Synergy Between Value-Based Insurance Design and Patient-Centered Medical Home," numerous strategies have been pursued to achieve the "dual objective of controlling costs and improving employee health." They said that research is emerging on the effectiveness at optimizing clinical outcomes and restraining costs.
Despite growing momentum on both fronts, the approaches are usually examined separately and therefore obvious synergies go largely unnoticed, the report stated. The authors are: A. Mark Fendrick, MD, professor at the University of Michigan departments of Internal Medicine and Health Management & Policy; Bruce Sherman, MD, Patient-Centered Primary Care Collaborative (PCPCC) Center for Employer Engagement, which is a coalition of groups working to advance the patient-centered medical home; and Dennis White, senior vice president for value-based purchasing at the National Business Coalition on Health, a national nonprofit membership organization of purchaser-led healthcare coalitions.
The medical home is a comprehensive primary care program in a healthcare setting that facilitates partnerships between patients, their personal physician, and when appropriate, the patient’s family. PCMH is a supply-side mechanism to enable clinicians to delivery better quality care more efficiently, according to the report.
"The PCMH fosters relationships between patients and providers, improves access, and increases quality and consistency of care," the report stated. "PCMH incorporates re-created office processes and payment systems to reward an ongoing physician-patient relationship and high-quality coordinated care."
"The PCMH requires an investment in financing, through either upfront payments or redesigned reimbursements, to help providers implement and sustain a model," the report adds. "Through better information management, use of guidelines, and coordinated care, the PCMH theoretically may contribute to better quality, which, in turn, drives cost reductions through avoided hospitalizations and emergency department visits."
VBID is an employer-driven design strategy to optimize use of higher value healthcare services and reduce use of lower value services. "The goal is to generate better results from employers’ healthcare expenditures," the report stated. "The underlying premise of VBID is getting more out of the healthcare dollar by removing barriers for essential effective services. VBID is a demand-side initiative that focuses on patient incentives to enhance use of medical services of proven value."
Value-based insurance design is included in health reform. It allows the Secretary of Health and Human Services to develop guidelines to permit health plans to use the concepts in providing coverage, according to Sherman.
"From an employer's point of view, PCMH and VBID are complementary, used to simultaneously change provider and patient behaviors," the report added. "The PCMH creates a system of healthcare delivery that offers high-value service. That value can be realized only if members use the medical home."
Health plans, employers, and public purchasers who have adopted one or both strategies include: the city of Battle Creek, MI; IBM; Geisinger Health Plan; Roy O. Martin, the small private company; and the Whirlpool Corp.
"While there is little agreement on the specific mechanisms, there is general consensus that the healthcare system is not delivering acceptable value in clinical outcomes, for the dollars spent. Many of the solutions proposed are highly consistent with the underlying principals of VBID and PCMH.
The systems provide:
- Better delivery of evidence-based practices
- Increased reliance on information management in healthcare.
- Cost sharing and reimbursement aligned with high value services.
- Coordinated multidisciplinary care
- Increased engagement of and attention to patients
"Although employers often implement VBID and PCMH initiatives in sequence, they see the logic for using them in tandem," the report stated. "From an employer's point of view, PCMH and VPID are complementary, used to simultaneously change provider and patient behaviors."
Joe Cantlupe is a senior editor with HealthLeaders Media Online.
