The Patient-Centered Medical Home

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 primary care provider. 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.
 
Defining the PCMH

The following comes from the Agency for Healthcare Quality and Research (AHRQ).

The medical home model holds promise as a way to improve health care in America by transforming how primary care is organized and delivered. Building on the work of a large and growing community, the AHRQ defines a medical home not simply as a place but as a model of the organization of primary care that delivers the core functions of primary health care.

The medical home encompasses five functions and attributes:
  1. Comprehensive Care - The primary care medical home is accountable for meeting the large majority of each patient’s physical and mental health care needs, including prevention and wellness, acute care, and chronic care. Providing comprehensive care requires a team of care providers. This team might include physicians, advanced practice nurses, physician assistants, nurses, pharmacists, nutritionists, social workers, educators, and care coordinators. Although some medical home practices may bring together large and diverse teams of care providers to meet the needs of their patients, many others, including smaller practices, will build virtual teams linking themselves and their patients to providers and services in their communities.
  2. Patient-Centered - The primary care medical home provides primary health care that is relationship-based with an orientation toward the whole person. Partnering with patients and their families requires understanding and respecting each patient’s unique needs, culture, values, and preferences. The medical home practice actively supports patients in learning to manage and organize their own care at the level the patient chooses. Recognizing that patients and families are core members of the care team, medical home practices ensure that they are fully informed partners in establishing care plans.
  3. Coordinated Care - The primary care medical home coordinates care across all elements of the broader health care system, including specialty care, hospitals, home health care, and community services and supports. Such coordination is particularly critical during transitions between sites of care, such as when patients are being discharged from the hospital. Medical home practices also excel at building clear and open communication among patients and families, the medical home, and members of the broader care team.
  4. Accessible Services - The primary care medical home delivers accessible services with shorter waiting times for urgent needs, enhanced in-person hours, around-the-clock telephone or electronic access to a member of the care team, and alternative methods of communication such as email and telephone care. The medical home practice is responsive to patients’ preferences regarding access.
  5. Quality and Safety - The primary care medical home demonstrates a commitment to quality and quality improvement by ongoing engagement in activities such as using evidence-based medicine and clinical decision-support tools to guide shared decision making with patients and families, engaging in performance measurement and improvement, measuring and responding to patient experiences and patient satisfaction, and practicing population health management. Sharing robust quality and safety data and improvement activities publicly is also an important marker of a system-level commitment to quality.
Learn more at the AHRQ's PCMH Resource Center.

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