Highmark Inc. Beginning Patient-Centered Medical Home Pilot Program Designed to Improve Coordination of Care

CAMP HILL, Pa., April 18, 2011 /PRNewswire/ -- Highmark Inc. is working with 13 physician practices throughout Western and Central Pennsylvania and West Virginia on a pilot program that establishes patient-centered medical homes (PCMH) in which physicians take greater accountability for coordinating care for their patients. The program will begin on June 1. The 13 practices will include 29 different locations, 160 physicians and will include about 45,000 members.

"The PCMH concept is one where a practice-based care team led by the primary care physician (PCP) coordinates all the care for the patient. This approach means working with the patients and their families across care settings to support their care decision making and to assist in coordinating the care experience," said Robert Nielsen, M.D., a primary care physician with Annville Family Practice. The practice is located in Lebanon County, Pa., and is participating in the pilot project.

Under Highmark's new approach to care, PCP reimbursement will be modified to provide compensation to help fund the practice's transformation to a patient centered medical home. Fundamental to the model is the implementation of care coordination, patient information transfer and clinical outcomes-based reporting.

"We are confident that these practices will improve patient care for Highmark members," said Mary Goessler, M.D., medical director of quality management at Highmark. "We believe by significantly improving communications and patient information exchange between primary care physicians, specialists and hospitals, coupled with working more closely with patients in coordinating care and establishing self management goals, we will realize a sustained improvement in care quality and patient outcomes. Over time, our goal is to slow the growth of care costs."

When a patient is transitioned from one care setting to the next, communication breakdowns can result in medication errors, duplicate tests and services and lack of proper patient follow up. Through better management and coordination of care, Highmark anticipates fewer hospital readmissions and reduced emergency room visits – a costly place to receive care.

"One of the key elements of the PCMH is that information technology is used appropriately and in a meaningful way to support optimal patient care, patient education and enhanced communication," said Dr. Goessler. "This approach will enable physicians to communicate more efficiently with the many caregivers who they speak with on behalf of patients. It will be easier to track records, maintain various registries and check compliance."

Highmark anticipates this new delivery model will help to improve and sustain optimal clinical outcomes and begin to positively impact health care cost trends. It will be considered for broader implementation throughout the Highmark primary care network, once data of the two-year pilot is assessed.

SOURCE Highmark Inc.