In 2011, one of Kansas-based St. Luke Medical Group's major payers approached the 18-office multispecialty group about joining a new quality initiative. The insurer would pay participating practices a monthly per-patient fee for coordinating the care of its members provided that each practice qualified as a Patient-Centered Medical Home (PCMH).
The offer triggered the group's decision to pursue National Committee for Quality Assurance (NCQA) recognition as a level 3 PCMH, the highest qualifying level. Even though the group was already moving toward a medical home style of practice, it would take another two years to satisfy all of the NCQA's requirements.
"We already had some of the elements of a medical home in place but there was still a lot to do," says Michael Munger, a family physician and medical director at St. Luke's South Primary Care in Overland Park, Kan., with 11 primary-care physicians and two NPs. "We had to really amp up our test and referral tracking and work on our transitions of care between the acute and ambulatory settings."
Not everyone in the group was on board at first, Munger acknowledges. But that changed as it became apparent that their hard work was paying off.
"We've started to see movement in the market since we became recognized in terms of payers reimbursing based on quality and performance, and that's bringing real dollars into the practice," says Munger. "Even the skeptics in the group are now saying that becoming a PCMH positioned us to be successful."
St. Luke's has already had one major component of a PCMH in place since 2009: EHRs. In addition, the group was already using some chronic disease measurements related to diabetes, coronary artery disease, and other common conditions, and was familiar with setting goals of care and tracking physician performance.
The group used the NCQA's list of six must-pass PCMH elements as an organizing framework for moving forward (see sidebar). In order to achieve level 3 recognition they would have to score at least 85 percent on 27 elements or standards within six broad categories of care: patient-centered access; team-based care; population health management; care management and support; care coordination and care transitions; and performance measurement and quality improvement.
Munger, who serves on the board of the American Academy of Family Physicians and was already well-versed in the medical home concept, took on the role of overall physician champion. In addition, each individual office appointed its own champion to help coordinate PCMH activities.
"I embedded myself with as much knowledge as I could," says Munger. "It was sort of a leap of faith because not much was changing in terms of reimbursement in late 2011 to 2012, but I felt we needed to move in this direction sooner rather than later."