Empowering Consumers in Patient-Centered Medical Homes
(Last year, the Robert Wood Johnson Foundation launched a joint initiative with Community Catalyst called the Value Advocacy Project (VAP). The project is supporting consumer health advocacy organizations in six states in their non-lobbying advocacy efforts to pursue local and state policy and health system changes that increase the value of health care by improving health outcomes and lowering health care costs, especially for populations that have disproportionately poor outcomes. Building on the Center for Consumer Engagement in Health Innovation’s recently released Consumer Policy Platform for Health System Transformation, we will be highlighting our state partners working on issues outlined in the policy platform and encouraging them to share how their work can translate to advocates across the country.)
Ohio is one of the nation’s unhealthiest states, ranking 40th in overall population health, yet we spend more per person than all but 15 states. Additionally, the state ranks last in racial disparities of infant mortality, speaking to the need for a more robust approach to health equity.
In 2009, Governor John Kasich created the Office of Health Transformation to change the way we pay for and deliver health care, to move from volume to value. Leveraging the influence of large self-insured employers, the administration brought together the four largest insurers, public payers and providers to develop a payment/delivery reform plan (described below), leading to the award of a federal State Innovation Model (SIM) Implementation Grant.
But what about the role of consumers? That’s where we come in.
In the next five years, Ohio plans to move 80 percent of Ohioans into two new payment models: Patient-Centered Medical Homes (PCMH) and episode-based payments. Episode-based payments refer to paying providers for treating a whole “episode of care,” such as joint replacement, rather than the individual services. This incentivizes providers to get the care right (they get paid the same even if the patient gets a bad infection requiring multiple hospitalizations), creates more price transparency and narrows the wide variation in charges among providers for the same treatment.
The SIM application talks about patient engagement, but we need to identify the strategies for building in robust and meaningful patient engagement. Furthermore, strategies for addressing population health also need to be identified. Thus our coalition, Ohio Consumers for Health Coverage, is focusing its Value Advocacy Project campaign on shaping the PCMH model of care as an instrument to improve population health driven by a robust, institutionalized consumer voice at all levels of Ohio’s health transformation efforts.
Regional PCMH collaboratives in Ohio demonstrate both the potential and challenges of relying on primary care transformation to make strides in population health. On the one hand, we’ve seen PCMH practices virtually eliminate racial disparities in delivery of diabetes care in Cleveland (check out Better Health Partnership). On the other hand, The Southwest Ohio Comprehensive Primary Care Initiative (which is one of seven sites in the federal CPCI initiative), has Medicaid covering only 5 percent of patients, due to federal restrictions. And CPCI’s patient population does not reflect the racial and ethnic diversity of Ohio. Yet, the Kasich administration is calling it the model for Ohio’s PCMH model.
On the plus side, a handful of PCMH practices in the southwest Ohio demonstration are using Patient-Family Advisory Councils (PFACs) to involve their patients in improving care quality – a best practice for patient engagement that we plan to promote as a state benchmark.
Where do we begin?
We’re working in three areas:
- Advocating that the Ohio PCMH model include standards and metrics to measure and improve consumers’ experience – including their participation in their care – and promote population health by connecting consumers to resources like patient self-management programs, housing and food assistance that improve their health and overcome non-health barriers;
- Building the voice of consumers at several levels: at the individual level by promoting expanded use of PFACs in PCMHs and recruiting consumers for them, at the systems level by getting consumers and advocates more vocal, at the regional collaborative levels in our three largest metropolitan areas and the policy level where we recently won four seats on the PCMH model design workgroup; and
- Ensuring that Ohio’s PCMH initiative promotes health equity, including institutionalizing effective use of community health workers to reduce health disparities and engaging the Ohio Statewide Health Disparities Collaborative in developing a health equity action agenda for this initiative.
Perhaps our greatest challenge is figuring out how to energize consumers in the three biggest metropolitan regions (and beyond) to get involved as advocates for better primary care that supports efforts to lead healthier lives. We hope to draw in people newly enrolled by community-based assisters, especially ones we trained and placed primarily in communities of color, as part of our enrollment follow-up activities to promote better health literacy and patient engagement. And we’ll turn to our activated enrollees in our integrated care (“dual eligibles”) demonstration, some of whom we are training for managed care plan consumer advisory committees.
Most of all, we plan to borrow promising practices from consumer advocates in other states who have been infinitely creative in causing a stir. Ohio needs a lot of creativity!
Author: Cathy Levine, Former Executive Director, UHCAN Ohio