What questions can I ask my health and pharmacy benefit plans to learn whether implementing a PCMH offering in my area makes sense?
Both medical and pharmacy claims data can provide support for informed decision-making regarding implementation of a PCMH program. Generally, low rates of use of preventive care or recommended disease-specific preventive care, low adherence rates for chronic medications, high rates of emergency department use or hospitalizations for chronic conditions may all indicate an opportunity to consider implementation of a PCMH offering. Additionally, it may also be worth inquiring whether the health plan is involved in PCMH activities elsewhere, either in the local market or elsewhere in the plan’s geographic business area. Finally, use the The Patient Centered Medical Home Purchaser Guide, an important resource developed by this Center, as a guide for discussions with your health benefits vendors.
