The role of primary care is extremely important when it comes to the success of accountable care organizations. ACOs turn to primary care offices for enhanced access to efficient care, care coordination (often using embedded care coordinators) and for population health management at the practice level.
At Mercy, we are building a clinically integrated network of employed and affiliated physicians that is part of a network of networks with our parent organization, Catholic Health Partners. In the first quarter of 2014, the Medicare Shared Savings Program ACO in one of our markets will be expanded across most of our networks in Ohio and Kentucky. As we welcome affiliated primary care practices into our clinically integrated network, we not only look at is as an opportunity to help them with electronic health records and health IT, but also to go to the next level and offer to help transform these practices into patient-centered medical homes. The PCMH model bolsters the efforts of a CIN/ACO. PCMH practices truly are building blocks of operations for primary care within clinical integration.
Nationwide, just 25 percent of physician practices are recognized as patient-centered medical homes by an outside 
standards entity such as National Committee for Quality Assurance. The majority of small, independent physician practices have difficulty making the transformation into a medical home on their own due to capital and transformation resource limitations. Within health systems and clinically integrated networks, PCMH transformation now is similar to what EHR implementation was a few years ago for these practices. Small, independent practices often did not have the capital nor resources available to implement EHRs on their own, so hospitals and health systems, along with federal incentives such as EHR meaningful use, stepped in to assist and now most primary care practices have implemented EHR systems. The next frontier is helping primary care practices transform into PCMHs.
Before beginning the journey together to help affiliated practices become medical homes, there are some questions that need to be answered.
What is the ACO looking for from primary care affiliates?
There are certain characteristics ACOs look for when it comes to choosing affiliated physician practices. At Mercy, we focus on the following three functions:
• Primary care access
• Practice-level population health management
• Embedded care coordinators
Not all practices have these capabilities at the beginning, but they are essential to PCMH function and for ACO success. So we focus on those three aspects of medical homes first during the transformation journey as short-term goals.
After focusing on the three functions, the long-term goal can be total PCMH transformation leading to recognition from NCQA.
What are affiliated practices willing to do?
There can be a disconnect between what a practice is willing to do and what a system is looking for out of the transformation. Generally, the practice's physicians are concerned about their daily operations and how the transformation will affect that, while the ACO is looking at the bigger picture of population health management.
Take the issue of access, for instance. Increased patient access is needed by the ACO, but access issues greatly affect the practice's operations. So the practice may need to improve operational efficiency before it is able to increase patient access to the office.
It is important to factor in the individual practice's point of view when developing a strategy for PCMH transformation. We want to capitalize on the physicians' and teams' strengths, passions and interests to get a few quick wins that will energize the practice to complete the lengthy full transformation.
How is the ACO willing to assist the affiliates?
After we determine what the practices are willing to do, we discuss more directly how the ACO will assist the practice in those efforts. With some, initial EHR implementation is the first step. Increasingly though, transitioning from a legacy EHR to the EHR being used by the network is the first step. In either case, many of our PCMH processes are introduced as workflows within the EHR.
Mercy and Catholic Health Partners have developed our own internal transformation team and market-based PCMH transformation coordinators, which are our first option to use in the affiliated practices joining the CIN. As we expand, we may need to use some outside resources to supplement our internal teams.
After determining what the ACO is looking for, what the practices want and how the ACO can best assist them, the last step is to understand the funding and to set priorities.
Helping affiliated practices become PCMHs is a win-win-win situation: Patients win because they receive better care at a lower cost, the practices win because they receive assistance and can better serve patients while improving professional and staff satisfaction, and the ACO and health system win since medical homes will help the organization improve on quality and cost metrics while better serving the populations under our care.
At Mercy in Northwest Ohio, we have already transformed 21 practices into patient-centered medical homes recognized by the NCQA in two years. Across Catholic Health Partners, approximately 75 percent of our primary care practices have reached NCQA recognition over the last three years. As we look to expand our clinically integrated network and speak with other practices, most are interested in joining and becoming medical homes.
Ken Bertka, MD, is a family physician and Chief Medical Officer of Mercy Medical Partners and Mercy Clinically Integrated Network at Toledo, Ohio-based Mercy, part of Catholic Health Partners.