BUSINESS CONSULT
KATY REED, MBA
Senior Manager, ECG Management Consultants
EMMA MANDELL
Manager, ECG Management Consultants
Beyond Primary Care:
Expanding the Medical Home
to Cardiology
T
he patient-centered medical home (PCMH)
model is mainly applicable to primary care
medicine. This care model is beginning to
pique the interests of specialists across the country,
including independent and employed cardiology
groups. The primary objective of the PCMH model
is to promote comprehensive, coordinated, and integrated care by using care teams to more effectively
manage acute and chronic conditions and provide
preventive services. This, in turn, keeps patients
healthy and out of more costly care settings.
Even when a PCMH is able to reduce unnecessary specialty visits by better managing the health
of a population, some patients will still require
more costly specialty care, such as cardiovascular
services. The management of cardiovascular conditions frequently involves complex care protocols
and extensive multidisciplinary input. As a result,
cardiologists often find themselves serving in a
dual primary care/cardiology role. This places
more responsibility on the cardiologist to find effective ways to ensure care coordination among all
of the patient’s core providers and to balance the
level of medical management and procedural care
needed for each cardiology patient’s particular
condition.
One approach gaining traction in the cardiology
care arena is the specialist medical home model. In
2013, the National Committee for Quality Assurance
(NCQA) launched the Patient-Centered Specialty
Practice (PCSP) Recognition program, which is aimed
at aligning specialty care models, including cardiology,
with those of their primary care counterparts. The requirements of the PCSP program closely mirror those
of the PCMH model and align with other measures
and initiatives (FIGURE), such as CMS’ EHR Incentive
Programs with regard to meaningful use and the Agency for Healthcare Research and Quality’s Consumer
Assessment of Health Providers and Systems (CAHPS)
patient experience tool.
Though PCSPs are still in the early stages of
adoption, there are already more than 800 specialty
care clinicians, including approximately 100 cardiologists, operating in NCQA-recognized medical
54 CardioSource WorldNews
FIGURE
PCSP Requirements
homes of this type. Interest
in this model is growing,
especially among specialties
such as cardiology where
patients require extensive
care across multiple services
and as clinicians recognize
the value of providing
comprehensive, coordinated
care for patients through a
medical home.
Through the PCSP model,
cardiologists can focus on
p roviding coordinated, comprehensive patient-centered
care, similar to their “neighbors” in primary care. Additionally, cardiologists benefit from:
• Opportunities with other providers, payers, and
federal/state agencies that might be looking to
partner with cardiologists to expand their networks or develop value-based payment arrangements and initiatives.
• Increased volume and/or referrals as more
patients are cared for in medical homes and as
the medical-home model evolves into the “gold
standard” for care.
• Improved access to comprehensive care, as well
as enhanced patient safety and satisfaction, and
referral management.
• Enhanced processes and efficiencies in care delivery, allowing more time for cardiologists to focus
on clinical care and less time spent on other tasks
(e.g., phone calls, emails, letters, reports).
• Opportunities to more closely align and coordinate care with primary care.
• New reimbursement mechanisms, which are
similar to those currently offered in primary care
(e.g., care management fees, bundled payments,
global payments) that will support cardiologists
under a medical-home model.
What this means is that clinicians in PCMHs and
cardiologists in PCSPs will be working from the
same “blueprint” in terms of care coordination and
management, as well as with similar incentives to
make care more accessible and efficient. They’ll essentially “reside” in the same medical neighborhood,
thereby facilitating navigation for a patient population that requires both primary care and specialty
services (and wants the same level of care from all
providers).
Establishing a PCSP is not simply a matter of deciding to do so or applying for accreditation. Changing
an organization’s care-delivery model entails a number
of operational and cultural changes, which require
considerable time and commitment to implement.
However, it is important to note that the PCSP model
is emerging as a critical component of specialty care.
Market forces continue to spur the development
of primary and specialty care-delivery models that
focus on value instead of volume, and specialists
who postpone care redesign will struggle to remain
viable in the future. Therefore, cardiologists must
consider how they can better design care delivery
specifically for cardiac patient populations. Cardiologists who truly embrace the PCSP approach will be
well positioned to provide better patient care, resulting in improved outcomes and lower costs. With an
effective PCSP in place, cardiologists can truly focus
on what really matters: delivering value-based care
that is truly patient-centered. ■
Please contact Emma at [email protected] or Katy
at [email protected] with any questions or for more
information on care-delivery transformation.
October 2015