By William K. Faber, MD, MHCM
Chief Medical Officer
The Patient Protection and Affordable Care Act (PPACA) of 2010 calls for improvements in health care delivery that will increase quality outcomes and access for patients, and simultaneously reduce costs. For years, physician and hospital associations, as well as independent and governmental watchdog groups, have been concerned about the growing complexity of health care in the U.S. and its effect on the provider and the patient. The Institute of Medicine’s 2001 Report: Crossing the Quality Chasm called for sweeping change, saying, “today is characterized by more to know, more to do, more to manage, more to watch, and more people involved than ever before.” Healthcare is currently fragmented and therefore inefficient and often ineffective.
The American Academy of Pediatrics (AAP) had the same concerns 35 years ago when it introduced the concept of a “medical home”. The objective at that time was to foster development of a centralized archive of a child’s medical records enabling one, centralized team to orchestrate the care of that child. Building further on the concept, the AAP expanded the model in 2002 to focus on the medical home as a means of improving access and enhancing communication among members of the health care team to ensure a lifetime coordination of care for patients. In 2007, the American Academy of Family Physicians, The American College of Physicians and the American Osteopathic Association joined the AAP in endorsing the Joint Principles of the Patient-Centered Medical Home.
PCMH: A Definition
The PPACA includes several provisions that promote the development of patient-centered medical home (PCMH) in accordance with these joint principles. PCMH is a model of care delivery that calls for the primary care physician to manage the patient’s care in collaboration with the patient. A PCMH has five central principles. It is:
Comprehensive—a team, led by the patient’s personal physician, is accountable for responding to the majority of the patient’s physical and mental health needs across the continuum of prevention and wellness, acute and chronic care.
Patient-centered—the emphasis is on the needs of the patient rather than the convenience of the health care provider team. The team takes into account all the aspects of life that affect one’s health, including things like the patient’s social environment, economic means and transportation challenges. The PCMH promotes patient empowerment to manage their own condition rather than fostering dependence on the health care team.
Coordinated—this requires coordination of care amongst all health providers involved in the care of the patient, across various specialties and facilities. This requires clear, open and timely communication, and optimally, the use of electronic health records. The PCMH team takes responsibility for coordinating care between transition points.
Accessible—this calls for shorter wait times for office appointments, expanded office hours, and 24-hour access to the team for advice by phone or other forms of electronic communication. It means being available when the patient perceives need.
Safe and of High Quality—this requires use of evidence-based clinical guidelines and decision-support tools that allow for shared decision making with patients and families. This also requires engaging in performance measurement and improvement, practicing proactive population health management and measuring, and responding to, concerns of patient satisfaction.
PCMH Benefit: Cost Savings
Statistics show that higher spending on health care in the United States has not equated to higher quality outcomes. Americans are aging and, according to the Centers for Disease Control, half the population is living with some form of chronic illness. Numerous physician groups and health care organizations have undertaken pilot projects to investigate whether the PCMH model can address costs and improve the patient experience.
The Patient-Centered Primary Care Collaborative, representing more than 1,000 medical home stakeholders and supporters throughout the U.S, conducted a 2012 review of 46 medical home initiatives throughout the United States. Results confirm that the medical home model reduces overall costs by reducing inpatient care, emergency department use, hospital readmissions, and other expenses. Duplicate testing, unnecessary procedures and redundant prescriptions can be eliminated as well, as care is tracked by the PCMH team, which holds itself accountable for the overall well-being of its patients.
According to the Patient-Centered Primary Care Collaborative, PCMH patients are more likely to seek “the right care in the right place at the right time” Better management of chronic illness improves outcomes, and a focus on wellness/prevention reduces the incidence of such illness.
PCMH Benefit: Higher Physician and Patient Satisfaction
Beyond cost savings, a PCMH environment promotes division of duties through a team model of care that enables the physician to maximize their meaningful interaction with patients and spend less time on activities that should be done by others. This helps preserve primary care physicians, who are in danger of going “extinct” due to the pressures of traditional models of care.
Patients also report higher satisfaction in a PCMH, due to better access and care coordination and an overall feeling that they are being looked after proactively.
PCMH Benefit: Payer Satisfaction
PCMH is a comprehensive response to health care reform. There is broad support among public and private sector payers to reward patient-centered medical homes, due to the efficiencies they create to decrease the overall cost of care. According to the National Academy for State Health Policy, Medicaid payments to medical homes are underway in Illinois, but the transformation required for a practice to become a PCMH can actually serve providers in the present fee-for-service model as well, as access and efficiency increase.
Many groups are also finding that developing a PCMH model helps them to comply with the Centers for Medicare and Medicaid Services (CMS) Physician Quality Reporting System (PQRS) and electronic health record Meaningful Use incentive program.
Implementing a PCMH approach within a health system helps to standardize its best practices, especially those related to access, quality and safety. PCMH also provides an exceptional framework for clinically integrated networks (CINs) and accountable care organizations (ACOs).
Preparing for the Future
Cost savings, time savings, potentially enhanced reimbursement, increased patient satisfaction; improved health quality outcomes and provider satisfaction are all potential benefits of adopting a PCMH model.
Several organizations officially “recognize” practices that demonstrate transformative effects that live up to the Joint Principles of PCMH discussed above. This recognition entitles these practices for enhanced reimbursement in many communities.
About the Author
Dr. William K. Faber, Chief Medical Officer for Health Directions, is a physician executive with progressive senior leadership experience. He most recently served as Senior Vice President of the Rochester General Health System in New York, where he guided the development of the system’s Clinical Integration program and assisted more than 150 providers at 44 sites through the conversion process from paper records to an Electronic Health Records system (Epic). Dr. Faber formerly participated in the governance of the Advocate Physician Partners (APP) Clinical Integration program and directed APP’s Quality Improvement Collaborative.