Highmark and PinnacleHealth System partner to expand Patient-Centered Medical Home efforts in Central Pennsylvania

Feb 28, 2013, 10:00 ET from Highmark Inc.

HARRISBURG, Pa., Feb. 28, 2013 /PRNewswire/ -- Based on the success of Highmark Inc.'s Patient-centered Medical Home pilot program, PinnacleHealth System is expanding its participation in the program to include all PinnacleHealth Medical Group (PHMG) practices.

The pilot included one PHMG practice, Colonial Park Family Practice. The expansion encompasses 22 practices and 75 primary care physicians.

The main goals of the initiative is to improve the patient experience and medical outcomes through enhanced patient education, better use of tools such as electronic health records and enhanced patient-doctor communication.

"We recently had a patient who visited the emergency room. He hadn't been diagnosed as diabetic, but he had very high blood sugar. He was treated and released. Thanks to the nursing care team that had been implemented at Colonial Park Family Practice, we were able to reach out to the member and have him come back for a follow-up visit a day or so after his emergency room visit," said Kevin Kelly, M.D., a family physician at PinnacleHealth. "This time his blood sugars were still very high, so we treated him, offered diabetic education and provided him with a glucometer, which likely helped him to avoid another emergency visit." 

Dr. Kelly also credited the nursing care team implementation in getting the patient quickly into the office for follow up and treatment. The plan is to implement nursing teams in all of the health system's practices. 

"We have a number of very positive stories just like this one as result of working closely with Highmark and their entire team to implement the PCMH model," said Kelly.

"We have been working with a number of physicians and health systems to implement PCMH, and PinnacleHealth has been an outstanding partner. They see the value of this model and the importance of emphasizing quality and improving the patient experience," said Matthew Vogel, vice president for provider contracting and relations at Highmark. "They have also developed a computer based PCMH curriculum which all PinnacleHealth Medical Group employees are required to complete."

The expansion of Highmark's PCMH program includes more than 171,000 patients. Highmark's pilot program showed that the PCMH model reduced overall care costs by nearly two percent. The pilot also demonstrated positive results by reducing seven and 30-day readmissions.

"We want the team to use proven strategies to prevent disease and complications, rather than wait for the patient to present in crisis," said Kelly.

Vogel also explained that the payment system for healthcare is changing. Rather than simply paying health care providers for volume, Highmark continues to place more emphasis of paying for value. If there are not cost savings in the program and quality improvements, there will not be enhanced payments to physicians.

SOURCE Highmark Inc.