Methodist Health System's Approach to PCMHs and ACOs: Q&A With Dr. Melissa Gerdes

Methodist Health System in Dallas has been making giant strides in its accountable care strategy recently. In March, the system announced 26 Methodist Family Health Center physicians were recognized by the National Committee for Quality Assurance as members of patient-centered medical homes. In Texas, 26 of the 120 NCQA-recognized entities are Methodist Family Health Center physicians, making more than 20 percent of NCQA 2011 PCMH recognized physicians in Texas Methodist physicians.

The system is also part of the Medicare Shared Savings Program, with four hospitals and 220 physicians participating in its accountable care organization, the Methodist Patient Centered ACO.

Melissa Gerdes, MD, the CMO of outpatient services and ACO strategy at Methodist and the medical director of the system's ACO, led the charge to obtain patient-centered medical home recognition for the system's employed physician base. She also helps guide Methodist Health System's overall accountable care strategy. Here, she discusses Methodist Health's journey to patient-centered medical home recognition and shares some tips for physician engagement in accountable care strategy.

Question: Why did Methodist originally decide to pursue the patient-centered medical home model?

Dr. Melissa Gerdes: We pursued it for our employed primary care physicians — they are employed by a subsidiary of Methodist called MedHealth. We have 46 primary care physicians in different clinic sites. Our 11 south clinics were recognized in 2012 and we are in the process of obtaining recognition for our five north region clinics as we speak.

It took 300 man hours to get the documentation together for the applications, and we attached 150 supporting documents to each clinic's application. Gerdes

One of the reasons we pursued PCMH recognition is because we felt that our clinics and physicians were, for the most part, already operating as patient-centered medical homes. They had been monitoring data for quality parameters and working to improve quality scores and were looking at patient satisfaction survey scores and working to improve those results as well. The clinics already offered same-day appointments and an online portal for patients and had been improving communication with referring physicians. Our clinics were not doing 100 percent of the things required for PCMH recognition, but completing the applications gave us a roadmap to complete the other 20 percent.

The second reason we pursued PCMH recognition is that it also allows us to participate in commercial payor pilot programs. Being NCQA-recognized is usually a baseline requirement for payor-sponsored pilots that are offered.

Q: Do you have any tips to share for other organizations pursuing the PCMH model?

MG: I think you need to define the scope of the project — identify which physicians and clinics will be applying for recognition.

I also recommend having a centralized steering team, which should include physicians, nurses, information technology specialists and a communications coordinator to manage information flow. Assemble the team, decide who is participating and leave enough time to complete the application — doing an application usually takes about a year.

I recommend getting ongoing feedback from NCQA during the application process, because they are looking for specific information.

Finally, use gap analysis tools to assess where you are starting and what you need to do to reach PCMH level.

Q: How does the PCMH model fit in with the system's larger accountable care strategy and ACO?

MG: I think PCMHs are the foundation of any ACO. If you try to build an ACO without them, you are basically building a house without a foundation and it will crumble.

But having recognized PCMHs is not enough to be an ACO. They are primary care practices and they do what they can do, but there are other places people seek healthcare, such as ASCs, rehabilitation facilities and nursing homes. ACOs are more of a medical neighborhood and the PCMHs are the homes. The ACO is wrapped around them.

When you go from medical homes to an ACO, you're dealing with a lot more partners, people and variability. Communication between physicians and locations of care and information technology support become very important. The patient continues to be the center of the structure — individuals need to be empowered and be a partner in their care.

Q: A recent survey by Deloitte showed many of the nation's physicians are unfamiliar with PCMHs and ACOs. How has Methodist encouraged physician engagement in its accountable care efforts?

MG: That doesn't surprise me. A lot of physicians are accidently or purposefully unaware of these programs.

The concept is really only eight years old. In medicine, the time from innovation discovery to the time a concept is widely adopted is 17 years. You can compare that to the grocery industry, where discovery-to-implementation time is 18 months. Knowing that, it doesn't surprise me that we're eight years in and have a lack of familiarity. We haven't hit a tipping point yet where physicians need to know about PCMHs.

I think the best way to approach communications with physicians is using multiple modalities. You can't just use an email blast or a billboard and think that is going to work. There has to be multiple types of education. At Methodist, we've done educational seminars, face-to-face meetings and webinars for physicians and we cast a very wide net when we invited physicians to participate in the ACO. We have quite a few participating physicians at 220. Of those, only 46 are employed by the system, so we've done a good job educating the majority of physicians on our medical staff. It was a year-long education process.

Q: What are some accountable care goals Methodist hopes to achieve as a system this year?

MG: We have 14,000 Medicare beneficiaries in our ACO, and one goal we have is to assist them in finding a medical home they can depend on and a primary care physician they can have a relationship with. That's an ongoing project.

We're also building out a care management department, where nurses will be available to coordinate patient care and help with the sickest individuals in our pool of 14,000 beneficiaries. Those are patients who spend a lot of time in the hospital and have multiple complex medical problems. The nurses will reach out to try to coordinate care and achieve better health. We are also looking at putting together a preferred provider network based on quality metrics for home health, skilled nursing and rehabilitation facilities.

Finally, since we're in a shared savings pilot, we want to provide comprehensive medical care at a cost savings.

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