The Amerigroup Patient-Centered Medical Home

The Amerigroup Patient-Centered Medical Home

Programs and Practices
External Communications
The Amerigroup Patient-Centered Medical Home
The Amerigroup Patient-Centered Medical Home (PCMH) strategy, also referred to as our “Advanced Medical Home”
initiative is focused on improving the quality and efficiency of the care delivered to our members. We do this through
transforming our delivery system and collaborating closely with providers of health care services. Our most valuable
resource for improving quality and controlling costs is our primary care network. The core of this strategy is focused upon
devoting resources to our Primary Care Providers (PCPs) to assist them in becoming highly functioning PCMHs. We
have engaged a nationally-recognized PCMH consultant, TransforMED (a wholly owned subsidiary of the American
Academy of Family Physicians), to assist us in our PCMH initiative. TransforMED has been engaged to provide training,
practice assessment and subject matter expertise assistance to our local market medical practice consultants. This
strategy requires a fundamental change in our relationship with providers to one of intense, on-the-ground collaboration.
Our model includes development of innovative payment models that
reward value rather than volume. Our PCMH strategy is building a
delivery system for Amerigroup members designed to produce better
outcomes, higher quality, and lower costs.
PCMH by the Numbers
What is Provider Collaboration?
The Amerigroup PCMH model is driven by provider collaboration, our
strategy of engaging with our providers to help them ultimately
deliver better health care services – both to Amerigroup members
and to their other patients.
What is Amerigroup currently doing?
Amerigroup is actively engaging PCPs and practitioners to become
PCMHs. Through currently participating practices, 145,018 Amerigroup
members are affected by our PCMH strategy in eight states. We have
already engaged more than 59 PCMH sites, encompassing 637 PCPs.
How is Amerigroup doing it?
59
Amerigroup PCMH groups
637
Participating PCPs
145,018
Amerigroup members
covered by a PCMH
Amerigroup is extending our capabilities to support our PCPs
with information about their patient population through:
• Developing quality and medical cost management reports
• Extending our quality nurses to become quality coaches
• Employing medical practice consultants to help practices
facilitate practice change
• Integrating our case managers with PCPs to extend their care
management capabilities
12/2012
Watch video of how an Amerigroup Tennessee practice is putting the PCMH model to work.
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The Amerigroup strategy aligns with the Seven Joint Principles of the PCMH, as defined by the American Academy of Pediatrics,
American Academy of Family Physicians, American College of Physicians, and the American Osteopathic Association:
1.Personal physician providing first contact, continuous and comprehensive care
2.Physician-directed medical practice in which a team of individuals who take responsibility
for the ongoing care of patients
3.Whole person orientation driven by a PCP responsible for all of a patient’s health care needs
4.Care coordinated and integrated across all elements of the complex health care system and the
patient’s community
5.Quality and safety ensured by incorporating a care planning process, evidence-based medicine,
accountability, performance measurement, mutual participation and decision making
6.Enhanced access to care available through open scheduling, expanded hours and new options for
communication between patients and practice staff
7.Payment appropriately recognizes added value provided to patients beyond the traditional fee-forservice encounter; aligned incentives pay for outcomes, not volume
We are aligning our processes and staff so that we can identify and engage high impact, high value primary and secondary
care providers within each market to build deep and lasting service and care delivery partnerships that improve quality
and outcomes of care while lowering medical cost trends. A key factor in the success of our PCMH model is the sharing
of information between Amerigroup and participating PCP practices.
The following reports are included in the suite of Medical Home quality and medical cost management reporting (specific
to Amerigroup members) to the PCP practices as part of our PCMH initiative:
•Monthly member listing showing all members who have been assigned to the practice and prompting
PCPs to reach out to members who have yet to make an appointment
•Daily inpatient census showing all members currently in an inpatient setting, prompting PCPs to manage
the discharge planning of affected members
•Weekly ER report detailing all members for whom Amerigroup received an ER claim in the previous week,
a flag for PCPs to follow up with affected members
•Monthly predictive modeling report, illustrating the relative risk ranking of their members in terms of
likelihood to consume significant medical services resources in the future; a PCP uses this report to more
effectively treat a member’s specific condition or combination of conditions driving this risk ranking
•Monthly Potential Missed Care Opportunities report identifying members who have not yet had a test,
screening or visit for various quality of care indicators; for example, a report may prompt a PCP to reach
out to a member because of a missed breast cancer screening
•Quarterly Medical Cost Management report showing opportunities for the practice to more efficiently
manage care for their members, such as identifying local specialists that provide the same services at
lower costs
What are our next steps?
Amerigroup plans to expand its PCMH participation and member coverage in the eight states that have implemented
the initiative. In 2012, we are planning to launch the PCMH initiative in five additional states.