The goal of a patient-centered medical home (PCMH) is to deliver greater coordination of care through provider teamwork, patient communication, care management, and technology. Mounting evidence shows the PCMH model improves care outcomes and reduces costs. Yet most medical groups are reluctant to adopt this approach. The barrier is money. Although funding opportunities are expanding, most payers do not offer additional dollars for medical home care. A PCMH represents additional operating expenses with little or no increase in operating revenue.
Given financial realities, does it make sense to adopt the medical home model now? A growing number of medical group leaders think it is. First, the immediate benefits are real. Pilot programs across the country show that medical homes improve access to care, help ensure patients receive optimal care, and reduce utilization of high-cost resources. Second, the medical home model is a comprehensive response to healthcare reform. Many groups fi nd that a PCMH consolidates compliance with several programs—including the Centers for Medicare and Medicaid Services (CMS) Physician Quality Reporting System (PQRS) and electronic health record (EHR) incentive programs (Meaningful Use). A PCMH also supports participation in clinical integration initiatives and accountable care organizations (ACOs). In addition, the model can help groups prepare for future reform initiatives since it aligns with the “Triple Aim” of improving patient care, improving population health, and reducing healthcare costs. Third, the medical home model provides a clear plan of action. Unlike many recent initiatives, the PCMH model developed by the National Committee for Quality Assurance (NCQA) provides a straightforward platform of standards, performance factors, and scoring. Well-defined medical home certification platforms have also been developed by the Utilization Review Accreditation Commission (URAC), Accreditation Association for Ambulatory Health Care (AAAHC), and the Joint Commission (JCAHO). Groups that are reluctant to pour resources into a vague strategy are embracing PCMH.
The NCQA medical home recognition program is for primary care physicians (a specialist program is in development). Successful early adopters have used a systematic approach to achieving NCQA recognition. The key is to develop a step-by-step plan for transforming the way your group delivers patient care.