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Why it Makes Sense to Adopt the PCMH Model in 2013

Posted by Matthew Smith on May 22, 2013 1:44:00 PM
By Lucy Zielinski; Tina Wardrop; and Cindy Barrett, LPN

PCHM, Patient Centered Medical HomeThe 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.

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PCMH, Medical Home, Health Directions

Topics: ACO, Accountable Care Organization, AAFP, Family Medicine, AAP, AOA, PCMH, Patient Centered Medical Home

So...What Exactly is the Difference Between a PCMH and an ACO?

Posted by Matthew Smith on May 8, 2013 4:27:00 PM

PCMH, Patient Centered Medical HomeThe Patient-Centered Medical Home (PCMH) model was proposed by the American Academy of Family Physicians, American Academy of Pediatrics, American College of Physicians, and American Osteopathic Association in 2007.

It is, in essence, an enhanced primary care delivery model that strives to achieve better access, coordination of care, prevention, quality, and safety within the primary care practice, and to create a strong partnership between the patient and primary care physician. Like accountable care organizations, the medical home model is referenced many times in the current Affordable Care Act as one way to improve health outcomes through care coordination.

Medical homes are similar to Accountable Care Organizations in that they consolidate multiple levels of care for patients. However, medical homes take the approach of having the primary physician lead the care delivery “team.” Quite simply, an ACO consists of many coordinated practices while a medical home is a single practice.  A medical home has several key characteristics, including:

  • Designation of a personal physician– each patient has an ongoing relationship with a personal physician trained to provide first contact, continuous and comprehensive care.  Also, the personal physician leads a team of individuals at the practice level who collectively take responsibility for the ongoing care of patients.
  • Whole person orientation– care is organized around providing services for all of the individual’s health care needs.  The medical home takes responsibility for appropriately arranging care with other qualified professionals on an as needed basis.
  • Care coordination and integration – care across the spectrum of specialists, hospitals, home health agencies, and nursing homes is coordinated with the personal physician leading the effort.
  • Evidence and outcomes focus – the quality and safety of care are assured by a care planning process using evidence-based medicine, clinical decision-support tools, performance measurement and active participation of patients in decision-making.
  • Enhanced access to care – practices are “open” in the sense that scheduling is available to individuals, hours of practice are expanded hours and new communications options are deployed for the convenience of individuals seeking care.
  • Comprehensive payment model – payments for services for individuals enrolled in the patient-centered medical home reflect a comprehensive payment for services that extends beyond the face-to-face visit with the personal physician.

The Accountable Care Organization is also based around a strong primary care core. But ACOs are comprised of many "medical homes"—in other words, many primary care providers and/or practices that work together. Some have even dubbed ACOs the "medical village."

An ACO is basically a network of medical homes. It is a collaboration of different organizations and practices working together which may include primary care physicians, specialists, hospitals, providers, payers, etc. The ACOs take medical homes a step further in emphasizing the alignment of incentives and accountability for providers across the continuum of care. There is a need for very strong leadership to address cultural, legal, and resource related barriers when creating an ACO.

The difference is that ACOs would be accountable for the cost and quality of care both within and outside of the primary care relationship. As such, ACOs must include specialists and hospitals in order to be able to control costs and improve health outcomes across the entire care continuum.

ACOs by nature would be larger than a single medical home or physician’s office. There are many known benefits of the ACO structure over the medical home model, including the ability to better manage the care for a greater population of people with a larger budget. Being able to use the dollars across a wider range of patients and conditions allows for better overall cost management, less variation within the population, and the ability to track and trend for quality.

Topics: ACO, Accountable Care Organization, AAFP, Family Medicine, AAP, AOA, PCMH, Patient Centered Medical Home

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