PCMH SUSTAINABILITY BEST PRACTICES TOOLKIT
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For your practice to be sustainable, you must focus on establishing a consistent financial base. This is a strategic process that addresses your long-term needs and adjusts to changing trends, economic and political cycles, and investment highs and lows. Programs with diverse funding sources are less vulnerable to fluctuations when funding changes occur.
Under the typical fee-for-service (FFS) payment model, providers and practices are rewarded for volume (e.g., number of visits or procedures). However, payers who are interested in overall healthcare cost savings are finding ways to reward value (e.g., improved health outcomes).
Practices that adopt the PCMH Model of Care are well-positioned to benefit from accountable care organizations (ACOs) and other care delivery models that pay providers and facilities based on patient outcomes. Practices that meet the requirements of these programs may be able to increase their revenue. Even practices not eligible for enhanced PCMH payment or incentives may be able to increase their revenue by improving efficiency.
Stop 8: Financial Viability
What is Financial Viability?
SHIP Value-Based Payment Resources
These are the 2016-17 recorded SHIP PCMH Webinars and PowerPoint slides.
PCMH Financial Sustainability Toolkit
PCDC developed this toolkit to aid practices in figuring out the costs associated with sustaining the tasks of being a PCMH.
The Cost of Sustaining a Patient-Centered Medical Home: Experience From 2 States
This study’s aim was to assess a practice’s personnel costs associated with completing PCMH functions outlined by the NCQA.
Patient-Centered Primary Care Homes: Better Health, Better Care and Lower Costs
The Oregon Health Authority gives three case studies on the ROI of PCMH practices.
Creating Sustainability through Public-Private Partnerships: The Future of New Primary Care Models
This brief describes the major elements of PCMH initiatives and sustainability efforts in four states: Michigan, Vermont, Colorado, and Arkansas.
Advanced Primary Care: A Key Contributor to Successful ACOs
A quantitative analysis, explained in detail in the report, examines the relationship between successful ACOs and the presence of recognized PCMHs.
The Impact of Primary Care Practice Transformation on Cost, Quality, and Utilization
The 2017 evidence report reaffirms the PCMH has showed improved outcomes in terms of quality, cost, and utilization, but not uniformly.
This is the Patient-Centered Primary Care Collaborative (PCPCC) repository of PCMH program evaluation and outcomes data.
Review the resources. Then, return to your Notebook to answer questions, take notes, and record your thoughts.
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Here is more information on the benefits of PCMH transformation and how leaders can help.
PCMH transformation has many benefits for practices, including direct and indirect financial benefits. Direct benefits include efficiency and increased revenue. Indirect financial benefits result from improved provider and staff experience, which can decrease turnover and decrease recruitment costs.
Improved patient experience improves patient retention and qualifies practices for performance-based incentives.
How Can Leaders Help?
It is no surprise that PCMH transformation requires resources, namely time and money. Leaders can support transformation by championing the resources needed to complete the process. They can also advocate for payment systems that adequately support the enhanced functions of a PCMH. Practices able to successfully transform are better positioned for financial success in a rapidly changing healthcare environment. They will benefit from emerging payment systems and care delivery models that reward improved outcomes. They also benefit from the efficiencies they achieve through system redesign.
Keep in mind that the PCMH transformation and changes take time, and so does seeing the financial value. The financial gains from a PCMH are seen in the long-term and will not show up in financial statements for the first few years.
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