Provider Experiences with a Payer-Based PCMH Program

doi:10.1007/s11606-019-05005-7

Observational Study

. 2019 Oct;34(10):2047-2053.

doi: 10.1007/s11606-019-05005-7. Epub 2019 Apr 22.

Provider Experiences with a Payer-Based PCMH Program

Gilbert Gimm¹, Debora G Goldberg², Nouran Ghanem², Sahar Haghighat², Jay Want³, Dan Hough⁴, Len M Nichols²

Affiliations

¹ Department of Health Administration and Policy, George Mason University, Fairfax, VA, USA. ggimm@gmu.edu.
² George Mason University, Fairfax, VA, USA.
³ Peterson Center on Healthcare, New York, NY, USA.
⁴ Alan Newman Research, Richmond, VA, USA.

PMID: 31011976
PMCID: PMC6816616
DOI: 10.1007/s11606-019-05005-7

Observational Study

Provider Experiences with a Payer-Based PCMH Program

Gilbert Gimm et al. J Gen Intern Med. 2019 Oct.

. 2019 Oct;34(10):2047-2053.

doi: 10.1007/s11606-019-05005-7. Epub 2019 Apr 22.

Authors

Gilbert Gimm¹, Debora G Goldberg², Nouran Ghanem², Sahar Haghighat², Jay Want³, Dan Hough⁴, Len M Nichols²

Affiliations

¹ Department of Health Administration and Policy, George Mason University, Fairfax, VA, USA. ggimm@gmu.edu.
² George Mason University, Fairfax, VA, USA.
³ Peterson Center on Healthcare, New York, NY, USA.
⁴ Alan Newman Research, Richmond, VA, USA.

PMID: 31011976
PMCID: PMC6816616
DOI: 10.1007/s11606-019-05005-7

Abstract

Background: The patient-centered medical home (PCMH) is an enhanced primary care model that aims to improve quality of care. Over the past several years, the PCMH model has been adopted by Medicare and private payers, which offer financial resources and technical assistance to participating practices. However, few studies have examined provider experiences and perspectives on the adoption of payer-based PCMH models in different practice settings.

Objective: The goal of this qualitative study was to analyze how providers experienced specific elements of a payer-based PCMH model and identify cross-cutting themes that can be applied to other payer-based PCMH initiatives.

Design: Observational qualitative study.

Participants: A total of 65 individuals (which includes 57 primary care physicians) participated in focus group sessions. Telephone interviews were conducted with an additional 14 physicians and 2 practice administrators.

Approach: Interviews and focus groups were recorded after obtaining the informed consent of participants. Written transcripts from the recordings were then imported into NVivo 11 for subsequent coding and qualitative analysis of themes.

Key results: We found that nurse care coordinators (NCCs) were the single most valuable and visible program element. Individual care plans served as effective tools of communication between the NCC and physician on patient care management goals and issues. The online data portal was viewed as the least valuable element. With regard to cross-cutting themes, some providers expressed a strained relationship with CareFirst due to communication challenges, a lack of trust, and differing priorities in selecting patients for care plans.

Conclusion: Nurse care coordinators and the targeted use of individualized care plans are essential components in a payer-based PCMH program. Improving communication and trust in data reports are critical for effective implementation. Future research should examine provider experiences in other payer-based PCMH programs to see how interactions with payers affect program implementation.

Keywords: patient-centered medical home; provider experiences; qualitative.

PubMed Disclaimer

Conflict of interest statement

Dr. Want is an employee of the Peterson Center on Healthcare and Want Healthcare LLC. Mr. Hough is an employee of Alan Newman Research. Dr. Nichols discloses receiving honoraria from the following organizations: WC Research, Inc.; Navigant Consulting; Institute for International Research; Kaufman and Conoles, P.C.; Conent, Inc.; and the Center for Corporate Innovation. All other authors declare they have no conflicts of interest.

Comment in

Capsule Commentary on Gimm et al., Provider Experiences with a Payer-Based PCMH Program.
Smith CS. Smith CS. J Gen Intern Med. 2019 Oct;34(10):2188. doi: 10.1007/s11606-019-05143-y. J Gen Intern Med. 2019. PMID: 31342319 Free PMC article. No abstract available.

Cited by

Transforming Primary Care in New York Through Patient-Centered Medical Homes: Findings From Qualitative Research.
Weiss L, Griffin K, Wu M, DeGarmo E, Jasani F, Pagán JA. Weiss L, et al. J Prim Care Community Health. 2022 Jan-Dec;13:21501319221112588. doi: 10.1177/21501319221112588. J Prim Care Community Health. 2022. PMID: 35847997 Free PMC article.
Capsule Commentary on Gimm et al., Provider Experiences with a Payer-Based PCMH Program.
Smith CS. Smith CS. J Gen Intern Med. 2019 Oct;34(10):2188. doi: 10.1007/s11606-019-05143-y. J Gen Intern Med. 2019. PMID: 31342319 Free PMC article. No abstract available.

References

1. Patient-Centered Primary Care Collaborative (PCPCC). Joint principles of the patient-centered medical home, 2007. Available at: http://www.pcpcc.org/about/medical-home. Accessed on February 25, 2019.
1. O’Malley AS, Gourvetich R, Draper K, Bond A, Tirodkar MA. Overcoming challenges to teamwork in patient-centered medical homes: a qualitative study. J Gen Intern Med. 2015;30(2):183–192. doi: 10.1007/s11606-014-3065-9. - DOI - PMC - PubMed
1. Friedman A, Howard J, Shaw E, Cohen D, Shahidi L, Ferrante J. Facilitator and barriers to care coordination in patient-centered medical homes (PCMHs) from coordinators’ perspectives. J Am Board Fam Med. 2016;29(1):90–101. doi: 10.3122/jabfm.2016.01.150175. - DOI - PMC - PubMed
1. Geonnotti K, Taylor E, Peikes D, et al. Engaging Primary Care Practices in Quality Improvement: Strategies for Practice Facilitators. AHRQ Publication No. 15–0015-EF. Rockville, MD: Agency for Healthcare Research and Quality; 2015.
1. Alexander JA, Markovitz AR, Paustian ML, et al. Implementation of patient-centered medical homes in adult primary care practices. Med Care Res Rev. 2015;72(4):438–467. doi: 10.1177/1077558715579862. - DOI - PubMed

Publication types

Actions
Actions

MeSH terms

Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions

LinkOut - more resources

Full Text Sources
Miscellaneous
- NCI CPTAC Assay Portal

[1] Patient-Centered Primary Care Collaborative (PCPCC). Joint principles of the patient-centered medical home, 2007. Available at: http://www.pcpcc.org/about/medical-home. Accessed on February 25, 2019.

[2] Patient-Centered Primary Care Collaborative (PCPCC). Joint principles of the patient-centered medical home, 2007. Available at: http://www.pcpcc.org/about/medical-home. Accessed on February 25, 2019.

[3] O’Malley AS, Gourvetich R, Draper K, Bond A, Tirodkar MA. Overcoming challenges to teamwork in patient-centered medical homes: a qualitative study. J Gen Intern Med. 2015;30(2):183–192. doi: 10.1007/s11606-014-3065-9. - DOI - PMC - PubMed

[4] O’Malley AS, Gourvetich R, Draper K, Bond A, Tirodkar MA. Overcoming challenges to teamwork in patient-centered medical homes: a qualitative study. J Gen Intern Med. 2015;30(2):183–192. doi: 10.1007/s11606-014-3065-9. - DOI - PMC - PubMed

[5] Friedman A, Howard J, Shaw E, Cohen D, Shahidi L, Ferrante J. Facilitator and barriers to care coordination in patient-centered medical homes (PCMHs) from coordinators’ perspectives. J Am Board Fam Med. 2016;29(1):90–101. doi: 10.3122/jabfm.2016.01.150175. - DOI - PMC - PubMed

[6] Friedman A, Howard J, Shaw E, Cohen D, Shahidi L, Ferrante J. Facilitator and barriers to care coordination in patient-centered medical homes (PCMHs) from coordinators’ perspectives. J Am Board Fam Med. 2016;29(1):90–101. doi: 10.3122/jabfm.2016.01.150175. - DOI - PMC - PubMed

[7] Geonnotti K, Taylor E, Peikes D, et al. Engaging Primary Care Practices in Quality Improvement: Strategies for Practice Facilitators. AHRQ Publication No. 15–0015-EF. Rockville, MD: Agency for Healthcare Research and Quality; 2015.

[8] Geonnotti K, Taylor E, Peikes D, et al. Engaging Primary Care Practices in Quality Improvement: Strategies for Practice Facilitators. AHRQ Publication No. 15–0015-EF. Rockville, MD: Agency for Healthcare Research and Quality; 2015.

[9] Alexander JA, Markovitz AR, Paustian ML, et al. Implementation of patient-centered medical homes in adult primary care practices. Med Care Res Rev. 2015;72(4):438–467. doi: 10.1177/1077558715579862. - DOI - PubMed

[10] Alexander JA, Markovitz AR, Paustian ML, et al. Implementation of patient-centered medical homes in adult primary care practices. Med Care Res Rev. 2015;72(4):438–467. doi: 10.1177/1077558715579862. - DOI - PubMed

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

Provider Experiences with a Payer-Based PCMH Program

Affiliations

Provider Experiences with a Payer-Based PCMH Program

Authors

Affiliations

Abstract

Conflict of interest statement

Comment in

Similar articles

Cited by

References

Publication types

MeSH terms

LinkOut - more resources

Full Text Sources

Miscellaneous