An article entitled “Holistic less compartmentalization” was published in the June 22 edition of MiBiz.
http://www.mibiz.com/absolutenm/templates/hctemplate.aspx?articleid=15464&zoneid=86
This particular subject happens to be one of my favorite hot buttons, and I felt the article deserved a response…
First, allow me to commend MiBiz for their coverage of the Patient Centered Medical Home (PCMH) concept in yesterday’s edition. The PCMH approach is widely supported by payers, providers, and legislators (a feat which itself is worthy of news coverage). The potential that PCMH holds as a step toward reforming our ailing healthcare system makes it well worth the attention that it has received in recent months. Unfortunately, and much to my disappointment, Grand Valley Health Plan & Family Health Centers, and our leadership in this area, were not included in the report.
The National Committee for Quality Assurance (NCQA), through its Physician Practice Connections® program, has established a standard for recognizing physician practices as Patient Centered Medical Homes. In order to achieve recognition, practices must submit to a rigorous process of review and inspection of required standards, including use of patient self-management support, care coordination, evidence-based guidelines for chronic conditions and performance reporting and improvement. The majority of commercial health plans in the U.S. (including BCBSM and Priority Health) participate with the NCQA annually. (www.ncqa.org)
To date, there is only one primary care provider in the state of Michigan that has been formally recognized by the NCQA as a Patient Centered Medical Home: Grand Valley Family Health Centers (see media release at http://www.gvhp.com/news.php?id=181). Our ability to perform at this high level was integral to our recent ranking as the #4 commercial health plan in the nation (only Harvard and Tufts University Health Plans scored higher) in the 2008 U.S News & World Report/NCQA Quality Survey. This position also makes us the highest ranked commercial plan in Michigan; Priority Health ranked #15 and BCBSM [Blue Care Network] ranked #71.(http://tinyurl.com/2fkven)
My intention is not to take shots at BCBSM or Priority Health. On the contrary I have the highest regard for both organizations and our shared commitment to positively impacting the quality of health in our community. However, to describe their recent contributions to PCMH initiatives as “major drivers” would seem to be an overstatement. Accomplishing the practice standards and outcomes necessary to achieve formal NCQA recognition requires a wholehearted and long-term commitment at all levels of the organization. It reflects a methodical & dedicated approach to care that has been at the core of Grand Valley Health Plan & Family Health Centers’ operating philosophy since our founding nearly 30 years ago.
In fact, BCBSM has developed a separate (and less stringent) set of PCMH standards from those supported by the NCQA. Participants in their program may then be considered a “patient centered medical home” without the need of submitting to NCQA guidelines. Which in effect creates a double standard, dillutes the value of PCMH recognition, and potentially undermines the concept’s original purpose. There is no doubt that BCBSM and Priority Health are the biggest commercial health plans in Michigan. However, at least where the Patient Centered Medical Home concept is concerned, it remains to be seen if bigger necessarily equates to better.
Healthcare Grand Rapids 