Patient-Centered Medical Home

toddSpring 2013

Connecting Patients With Providers

By Elizabeth Caldwell

Nettie Garrett, L.P.N., is a nurse care manager at UAMS South Central in Pine Bluff.

Nettie Garrett, L.P.N., is
a nurse care manager at
UAMS South Central in
Pine Bluff.

“It’s like having a quarterback on your team who is in charge of your care.”

That’s how Arkansas Surgeon General Joe Thompson, M.D., M.P.H., describes the patient-centered medical home model that UAMS is helping usher into the mainstream of health care in the state.

And he expects the new model for ensuring patients receive high-quality, coordinated and cost-effective care to bring about results as vital as any NFL championship playoff.

“Before, when you had an acute need, you had various health care providers taking care of you, but no quarterback,” said Thompson, also director of the Arkansas Center for Health Improvement and a professor at UAMS. “Now there is a quarterback assigned and fiscally accountable for the outcomes.”

The new model is essential to reforming how health care is provided and paid for, Thompson said. With Medicare and Medicaid costs rising faster than inflation, the medical home is expected to slow that rate by helping patients manage chronic conditions to avoid more hospitalizations and expensive treatments.

“I think it’s a great concept that is really connecting patients with providers,” said Daniel Knight, M.D., chair of the Department of Family and Preventive Medicine in the UAMS College of Medicine.

UAMS’ Family Medical Center in 2009 was the first in Arkansas recognized by the National Committee for Quality Assurance (NCQA) as a patient-centered medical home.

Care managers are a big part of the process, following up to ensure a patient gets needed prescriptions upon discharge from the hospital and is following care instructions, for example.

Knight said the new method is showing results at the Family Medical Center, with hospital readmissions reduced from 21 percent to 14 percent in 2012.

Last year, the NCQA gave patient-centered medical home recognition to eight UAMS regional family medical centers: one each in El Dorado, Fayetteville, Fort Smith, Jonesboro, Springdale and Texarkana, and two in Pine Bluff.

Mark Mengel, UAMS vice chancellor for Regional Programs, said results in the regional centers are encouraging as well. Patient outcomes improved nearly 7 percent in 2012. He expects improvement to continue, especially with the next phase of teaching self-management of chronic conditions, such as diabetes. That will take health coaches, case management and time for behavioral change, he said.

Strategic contact with patients is at the heart of the medical home. But it also emphasizes information technology upgrades, training the provider workforce to act as a team, and financial incentives to providers for meeting patient needs.

UAMS spent $6 million to hire additional personnel and purchase information technology to better integrate patient care at the regional centers. New software was used to create a disease registry and to standardize data entry for electronic health records.

Mengel and Knight said that paper records, make it difficult to track progress over time for conditions such as chronic obstructive pulmonary disease or high blood pressure. The electronic health records system can alert the provider if a patient misses a follow-up appointment or a referral to a specialist. It can alert the provider to check, for instance, on whether all patients with a certain condition have followed preventive measures.

“It helps us watch things and make sure they don’t fall through the cracks,” Knight said.