Ohio Medical Home Projects Surge Forward

The Patient Centered Medical Home (PCMH) movement in Ohio continues to pick up steam as state and national programs provide necessary funding for training and reimbursement mechanisms.

State Health Director Ted Wymyslo, MD, announced in June that his department has contracted with TransforMED to help fifty physician practices transform their offices into PCMHs.  At the same time, the Ohio Board of Regents is appointing a selection committee to award 50 primary care scholarships to  medical students who choose primary care careers. Most importantly, the CMS Center for Innovation and the Ohio Department of Job and Family Services are recruiting practices for care coordination projects under Medicaid and Medicare and providing necessary funding incentives to put the new model into effect.

"The Ohio Osteopathic Association, assisted by the Ohio ACOFP, is involved in all of these initatives, " said OOA Executive Director Jon F. Wills.  "We have representatives on advisory boards, serve as a nominating organization and are acting as a promotional partner to encourage our members to participate."

State And Regional Collaboratives Provide Leadership

Other administrative changes are also underway as a result of House Bill 487 (Mid-Biennium Budget Review), which cleared the Ohio General Assembly last month. Rather than serving as a free-standing committee without funding, the Patient-Centered Medical Home Education Advisory Group (PCMH-EAG), created by  HB 198, will begin operating as an advisory body to State Health Director Wymyslo, effective September 10. The Department has also created a PCMH division within the department and has engaged Primary Care Progress, Boston, MA, to help stimulate medical student  interest in primary care careers and implement PCMH curriculum at the medical school level.  

To be more reflective of populations served, the Ohio Patient Centered Primary Care Collaborative Collaborative (OPCPCC), also coordinated by the ODH, is recruiting additional membership for its six Learning Centers. These subgroups include Payment Reform, Communications and Marketing, HIT, Education, Patient Advisory, and Metrics. Richard J. Snow, DO, who was recently interviewed by Primary Care Progress about the PCMH education pilot project, represents the Ohio Osteopathic Association on the Collaborative steering committee and the PCMH Education Advisory Group. 

Regional PCMH efforts are being driven by the leadership of the The Health Collaborative of CincinnatiAccess Health Columbus, and Better Health Greater Cleveland. Physician practices that receive NCQA Certification  are now tracked and posted on a map at the health department website so Ohioans can find  medical homes in Ohio. (To locate practices on the map, select PCMH Level 1, 2, or 3 from the drop down at the top of the locator page.)  

Payment Reform Pilots Provide Incentives for Care Coordination

"The biggest challenge right now," said PCMH advocate Richard J. Snow, DO, "is the lack of a payment system in which there is shared responsibility across the continuum of care. Physicians try to practice pateint centric care, but are forced to yield sometimes because of the current fee-for service system."

That's why  the Comprehensive Primary Care Initiative (CPCI)  was created as one of the first steps towards payment reform under the Accountable Care Act.  The CPCI is a multi-payer initiative fostering collaboration between public and private health care payers to strengthen primary care. Medicare is working with commercial and state health insurance plans in eight states to offer bonus payments to primary care doctors who better coordinate care for their patients. Primary care practices that apply to participate in this initiative will be given resources to better coordinate primary care for their Medicare patients.

The Health Collaborative in Cincinnati, with assistance from the OOA and other primary care organizations, is leading efforts to recruit physician practices for the  project, which is limited to certain counties in the Cincinnati/Dayton geographical area.  The CPCI is working with 15 commercial and state insurance programs to provide up to $20 per Medicare patient per month to selected practices for  comprehensive patient coordination efforts designed to keep patients well.  Federal program administrators at CMMI will select up to 75 high performing primary care practices  by September 1, 2012: practices must apply on-line by July 20, 2012.

Similarly, Ohio Medicaid is collaborating with the Ohio Department of Mental Health to create Medicaid Health Homes for individuals who have serious and persistent mental illness (SPMI). The goal is to  integrate physical and behavioral health care and facilitate  access to medical, behavioral and social services that are timely, of high quality and coordinated by an individualized care team. Services provided will include comprehensive care management, care coordination, health promotion, comprehensive transitional care, individual and family support, and referral to community and social support services.  The Office of Health Plans (Medicaid) has invited community behavioral health centers to submit non-binding letters of intent, and the program will roll out in regions by October 1, 2012.  

Fifty Practices to be Assisted by TransforMED

The 50 primary care practices that were selected for help by TransforMED are practice sites for the HB 198 PCMH education pilot program and are affiliated with four of Ohio's medical schools and five nursing schools.  The participating medical schools include Ohio University Heritage College of Osteopathic Medicine, Northeast Ohio Medical University, University of Toledo College of Medicine and the Wright State University Boonshoft School of Medicine. For a list of practice sites, click here: PCMH Pilot Project Progress Report.

TransforMED is a subsidiary of the American Academy of Family Physicians and was founded in 2005 to help advance the PCMH model. The company was selected as a contractor by ODH after a request for proposal was issued earlier this summer, resulting in two proposals.  The ODH is currently working with TransforMED to establish timelines for deliverables and to work out necessary details to complete the work.

Since implementation of Electronic Health Records (EHR) is central to the PCMH model, the OOA is also helping its members implement, adopt and meet EHR meaningful use through the Ohio Health Information Partnership.  More than 665 DOs are currently being assisted by the Partnership's Regional Extension Centers in order to take advantage of Medicare and Medicaid Incentive payments for EHR Implementation.  The Partnership was founded by the OOA, the Ohio State Medical Association, the Ohio Hospital Association, BioOhio and the State of Ohio, with the ultimate goal of enhancing health information technology so physicians and hospitals can provide comprehensive care for patients in a cost-efffective, efficient and holistic way.

Primary Care Scholarships To Be Awarded to Students Who Train in the PCMH Settings 

The Board of Regents (BOR) was required  by HB 198 to implement a primary care component of the Choose Ohio First Scholarship Program. The BOR has established criteria for granting its new primary care scholarships and is in the process of appointing a scholarship selection committee.  

Scholarship recipients must agree to participate in PCMH opportunities during medical school, commit to serving in primary care in Ohio for three years, and agree to accept Medicaid patients. In all there will be 50 total scholarships per year for medical students at the seven medical colleges. Each college would have at minimum three scholarship students. Colleges could earn additional scholarships according to defined criteria: (1) proportion of graduates entering primary care; (2) level of implementation of PCMH curricula; (3) student placement in primary care; (4) faculty distribution and budget allocated to primary care; and (5) number of graduates entering primary care and staying in Ohio. 

The initial set of scholarships will be allocated by year of graduation: 15 first year students, 15 second year students, 15 third year students, and 5 to students in any year of medical school. If students remain in the program, they will keep their scholarships moving into the next year. 

The Board of Regents has asked medical and nursing schools and other organizations named in the bill – including the OOA -- to nominate physicians to serve on a statewide selection committee.  The committee will be comprised of one primary care physician from each of the seven participating schools, each of whom shall meet one of the following criteria:

  • Four must be in active practice;
  • At least one from each of the following specialties: Family Medicine, General Internal Medicine and Pediatrics/Med-Peds;
  • A least one must be appointed by their respective specialty organization in Ohio, including the Ohio Osteopathic Association
  • The remaining three must be full-time training directors or department chairs in primary care at one of the participating medical schools.