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GE Healthcare Camden Group Insights Blog

Remind Me Again...What's the Difference Between an ACO and a PCMH?

Posted by Matthew Smith on May 8, 2015 9:54:28 AM

By Matthew Smith, Director of Business Development, GE Healthcare Camden Group

The 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 ("ACOs"), 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 ACOs 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 ACO 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, MSSP, PCMH, Patient Centered Medical Home, Matthew Smith, MSSP ACO

Five Reasons for Providers to Embrace Social Media

Posted by Matthew Smith on Jul 22, 2014 12:23:00 PM

Social Media, Physicians, Physicians today often find themselves asking, "Who has time for social media?" Since most providers are focused on the chaos of reimbursements, busy practices and healthcare reform, it's no wonder that social media time is not a high priority.

But if you’ve been paying attention to society, business, and commerce over the last few years, you would know that social media has developed a very effective purpose in helping professionals communicate, engage in professional development and build meaningful reputations in their fields.

Social media is also a very effective way for physicians to manage their online reputations, which has become more and more important in today’s competitive healthcare marketplace.

Many physicians will argue that engaging in social media could be beneficial, but also brings about a certain amount of risk. Dr. John Mandrola negates this argument in his MedCity News article titled, Doctors and Social Media: It’s Time To Embrace Change

Dr. Mandrola writes, “But I ask: What medical intervention, what shot at making things better, comes free of risk? A rule of doctoring is that to do good a doctor must risk doing harm. A distinguished heart surgeon once consoled me—after I had caused a procedural complication—that if I didn’t want complications, I shouldn’t do anything.”

Dr. Mandrola sees the “risk” argument as a confining attitude that many physicians often take – keeping them trapped in the same outdated rituals that have perpetuated the healthcare industry for years.

“In the hyper-connected world of 2014, medical professionals have reached a fork in the road. One path is a road well traveled. On this familiar route, we continue to keep our heads down, stay in the weeds, out of trouble. Don’t wiggle; don’t rock the boat; check the boxes; fill out the forms and accept what comes. Don’t dare engage in the online conversation. Choosing this path is like not treating a disease: less ownership confers less personal risk.”

Dr. Russel Faust provides five great reasons in his Whitepaper, Social Media Guide for Docs, 12 Tips For Beginners.  

  1. You will gain market share– yes, it will help grow your practice!
  2. You will be recognized as an authority in your area of practice (which will also growyour practice).
  3. You will be better connected with your patients: compliance with your diagnostic and treatment regimens will improve (healthier patients, reduced readmissions).
  4. Your patients will arrive to appointments better- educated, and take less time: it will streamline your work flow!
  5. Your patients will be less needy outside of your clinic: they will require less time on the phone with you and your nurses.
Social Media, Twitter, LinkedIn, Health Directions

Topics: twitter, facebook, linkedin, Practice Management, Practice Marketing, Matthew Smith, Social media

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