With the continued rise in the cost of health care in the United States, the health care industry is pressured to decrease the overall cost of health care; while simultaneously increasing quality of care. The patient centered medical home (PCMH) model of care, which promotes comprehensive, integrated, interprofessional and coordinated patient-centered care, has become a potential solution to this problem. The purpose of this project is to determine if changing the model of care in a Primary Care Practice (PCP) from that of a chronic and episodic model of care to a PCMH model of care improves the quality of care provided to its patients.
Methods:
Using the results of HEDIS (Healthcare Effectiveness Data and Information Set) scores provided by Amerigroup, Blue Cross Blue Sheild (BCBS) and United Healthcare (UHC) insurance companies, also called managed care organizations (MCOs), this evaluation project compared a PCP’s pre-PCMH HEDIS scores from each insurance company to its post-PCMH scores in three clinical areas: adult BMI assessment rates, adult diabetic HgA1c testing rates, and childhood immunization administration rates to determine if changing the practice’s model of care improved the quality of care it provided to its patients in those three clinical areas.
Results:
Using descriptive analytics, the organization demonstrated improvement in adult BMI screening rates for patients with Amerigroup, BCBS and UHC insurances, and improvement in childhood immunization administration rates for patients with UHC insurance. Chi Square statistics revealed improvement in adult diabetic HgA1C screening rates for patients with both Amerigroup and UHC insurance, improvement in adult BMI screening rates in patients with BCBS insurance, and improvement in childhood immunization administration rates for patients with UHC insurance.
Implications for practice:
Transforming to a PCMH model of care requires time, effort and resources; therefore, organizations demand quantifiable ways to measure such large-scale quality improvement (QI) efforts. HEDIS scores provide measurable ways to track the progression of clinical QI projects. The information this PCP gained from HEDIS scores provided them with opportunity to identify potential gaps in care, develop strategies for improvement, and track their efforts through trends in EHR (Electronic Health record) and insurance claims data. As a result, the PCP was able to demonstrate improved rates of care to all patients treated within the PCMH in at least one of the three clinical areas measured, regardless of payer source.
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