What is a Patient Centered Medical Home or PCMH?
 
It’s an approach to primary care that is completely different than the traditional way it’s been delivered and organized.
 
Why PCMH? 
Because the current way patients receive primary care is not working for either patients or providers. Wait times are long. It’s difficult to get in to see a provider.  And when you do get in, the visit is rushed. As a result,  huge populations of patients aren’t receiving recommended care. For providers, workdays feel completely chaotic and many doctors, nurses, and PAs frequently note feeling like they’re on a hamster wheel.
 
The Patient-Centered Medical Home is a new model, designed to correct many of the flaws of primary care. The basic premise is that the patient is at the center of care, receiving a full range of comprehensive services provided by a team of health professionals including social worker, nurse, pharmacist,  in addition to  the MD.  The team shares the responsibility of patient care, ensuring the patient gets all recommended preventive care (like a colonoscopy), chronic disease management (like help managing their diabetes), as well as acute care. They’re able to do this with the help of robust information technology like electronic medical records which allows each team member to know whose condition is under control, what the most up-to-date recommendations are for treating a certain condition, and how they are performing as a provider team. These models have been around for years, yet they are spreading rapidly across the states as more and more governments and insurers have been demanding that their patients be treated in these models. Why? Because the data shows that, in medical homes, patients get better quality of care, they’re more satisfied with their care, and they get this for lower overall health care spending.
 
The Joint Principles of the Patient-Centered Medical Home were created by all of the different primary care societies in 2007 to let the various payers know that they were receiving a high quality primary care product for their money. Without these principles, anyone could say they had formed a PCMH, and potentially obtain higher reimbursement for their services.  The principles include:
 

1. A personal physician who has an ongoing relationship with patients and follows them through the care process.
2. Physician directed medical practices where the MD captains a team of care providers who all share responsibility for treating a patient.
3. Whole person orientation in which the care team helps the patient plan out goals for all phases of their care needs. The office takes responsibility for facilitating future appointments and appointments with other providers.
4. Coordinated Care that uses a proven system for sharing information (like electronic health records) and information is clearly relayed to patients. Also, patients have the opportunity to receive care when and where they need it.
5. Quality and safety are the top goals and patients have an active say in all decisions made about their care.
6. Enhanced access means that patients have greater ability to make appointments and that spots are held open for patients with urgent needs.
7. Payment appropriately recognizes the added value provided to patients in a medical home, reflects care time outside of face-to-face visits, rewards monitoring of clinical data, and rewards providers for keeping patients health and needing less care.

 
In addition, the National Committee for Quality Assurance (NCQA), an organization often used to certify medical homes, adds additional PCMH guidelines such as: access and communication processes; patient tracking and registry functions; care management guidelines; patient self-management support; diagnostic test tracking; referral tracking; performance reporting and improvement; and advanced electronic communications.
 
What is Patient-Centered Care?
 
A patient-centered model of care builds relationships between providers and patients to meet all of a patient’s needs and treats the patient with dignity and respect by including them in the decision making process. This means that there must be great communication throughout treatment so patients feel they have all needed information, and so providers communicate with each other and with the patient at all stages care.
 
PCP’s blog  Progress Notes, often includes posts like this one about innovative ways in which care is literally moving to people’s homes.
 
Trainees all across the country are actively participating and helping in clinical innovations like the medical home.
 
Who currently cares about medical homes & why?
 
New regulations and payment systems at the federal and state level are rewarding practices for transforming into medical homes, and in many instances buyers themselves (businesses, insurers, patients) are demanding access to medical home practices.
 
The Federal Government wants medical homes: The Center for Medicare and Medicaid Services’ Innovation Center has embarked on a comprehensive primary care initiative that promotes these models across the country. 
 
States want medical homes: All but nine states have passed fiscal policies to promote the growth of medical homes within their states.
 
Insurers want medical homes: Private insurers like Blue Cross Blue Shield (BCBS) have proactively participated in medical home demonstration projects in several states. In addition, WellPoint announced in January that it will begin paying on average 10% more to primary care physicians who agree to adopt patient-centered care methods. Aetna recently announced that it will begin paying $2 to $3 per-member monthly bonuses to physicians at practices certified as patient-centered medical homes, and UnitedHealth Group recently announced intentions to adopt value-based contracts that financially reward quality and efficiency outcome measures.
 
Businesses want medical homes: Large organizations are tired of paying for fragmented care. Instead they want their employees’ healthcare managed. Several companies including Caterpillar, IBM, FedEx, General Mills, Microsoft, General Motors, GE and Xerox have all pledged support for medical homes and in many cases have refused to purchase care that is not based in the medical home model.
 
Patients want medical homes: Substantial evidence has been found to support increased patient satisfaction in successful medical homes. This is achieved by delivering the types of medical services that patients want.
 
Many providers, now want medical homes: A two-year national demonstration project that studied primary care practices that were transforming into PCMHs found :
 

• 58% increase in clinician satisfaction
• 66% increase in staff satisfaction
• 11% increase in practice revenue and
• 14% increase in clinician salaries