Using Patient Engagement Tools to Create PCMHs

To help meet meaningful use and create patient-centered medical homes (PCMHs), Mid-Atlantic Community Health Center Association (MACHC), based in Lanham, Md., decided to support offer patient outreach software from the Dallas-based Phytel to its 19 members.

MACHC, a nonprofit membership organization and the primary care association for Maryland and Delaware, provides healthcare to medically underserved and uninsured patients. One of MACHC’s main directives is to provide cutting edge tools for its member organizations to help them build PCMHs.

“With the marketplace shifting toward patient-centered medical homes and moving towards implementation of meaningful use, and also with the shift towards population management, we recognize that only implementing EMRs systems was not going to be enough,” says Miguel McInnis, CEO of MACHC.”

In light of today’s stretched economy and the increased number of insured patients, McInnis says that MACHC has to be very creative to expand care with limited resources and to offer members products that will make an impact. The patient outreach software allows the organization to reach out and reconnect with patients via telephone and recommend preventive or chronic care they need, including recommended visits, tests, procedures or follow-up care, and allows tracking and reporting of results of outreach efforts.

Baltimore Medical System (BMS), which operates six community health centers and six freestanding school based clinics, was the first to implement the patient engagement tool in March 2008. BMS first piloted the software with a few doctors to test the system, and chose to use the tool for all patient populations and all disease categories.

Jay Wolvovsky, CEO, BMS, says the software is very useful when interfaced with the organization’s EMR (BMS has an enterprise EMR system from the Chicago-based Allscripts) that allows clinicians to see how compliant their patients are with follow-up care and what interventions are still needed. Wolvovsky notes that reengaging with patients is a useful public relations and marketing tool to show patients that their healthcare is the primary focus. “It gave us a real head start with patient-centered medical home and also on meaningful use,” Wolvovsky says. “It started us down the road to setting up the kind of communication processes that we would want to have with our patients.”

Wolvovsky admits there were some integration issues early on, where data wasn’t pulling from the right places, but that was quickly fine tuned. He says BMS hopes to use e-mail engagement later this year, and hopefully text messaging in the future.

BMS’ has seen a seven-fold return on investment with the increased number of patient visits that this product has helped generate, and he also notes that more patients are compliant with their disease management.

The patient engagement tool is one of the many tools MACHC employs to educate health centers. The organization relies on sub committees like its clinical quality committee or its CFO committee to encourage health IT adoption via new tools, best practices, webinars, and case studies.

In July, four MACHC member organizations will be among 50 practices to take part in the three-year patient-centered medical home pilot sponsored by Maryland. Carriers like Aetna, Carefirst, Cigna, Coventry, UHC, and Medicaid managed care organizations will provide fixed payments to practices that attest to meeting National Committee for Quality Assurance (NCQA) criteria. “Our intent out of this process at the end of the day is that with the impending implementation of exchanges in both Maryland and Delaware, these tool sets we believe are going to be paramount in organizations being able to demonstrate the value in the marketplace,” McInnis says.

“We can’t rely on the federal government for everything,” McInnis adds. “We recognize that there are creative, innovative partnerships like the one we formed with Phytel that make sense to help advance our health centers and our stature within our marketplace. Our strategy over the next five years is to help support our health centers in expanding access to more people, drive down the cost curve, and add value to the broader marketplace.”