The patient-centered medical home (PCMH) is not a new concept, but it's getting increased attention as a result of the Patient Protection and Affordable Care Act (PPACA). Under the PPACA, the newly funded Center for Medicare & Medicaid Innovation will evaluate the effectiveness of medical home models. Many healthcare providers have already begun to implement the medical home model in an effort to provide more coordinated care, improve quality and decrease overall healthcare costs (read about Blue Cross Blue Shield of Texas and Carillion's implementation of a medical home model).
Some say that the PCMH model is just a new version of the "gatekeeper" model even though there are significant distinctions between the two. Under the new legislation, it is very likely that primary care physicians will play a more central role in the healthcare delivery system - more playing time on the field. So, what are the key tenets of a PCMH? The AAFP and the NCQA both lay out some basic requirements in their extensive checklists - but here are a few to get you thinking.
- On-going relationship with a personal physician
- Physician-directed medical practice
- Whole person orientation - care across all stages of life
- Coordinated care across all facets of the healthcare system and the patient's community
- Emphasis on quality and safety
- Enhanced access to care
- Payment reflective of various components - i.e. support adoption and use of health IT, e-mail and telephone consultation, separate fee-for-service payments for face-to-face visits, share in savings from reduced hospitalizations, additional payments for quality improvement
It will be interesting to see if a shift to PCMH models on a nationwide scale will in fact reduce healthcare costs while improving quality and outcomes. A shift in the paradigm, a procedurally-based payment system emphasizing the role of specialists to that of a primary care physician playing a larger role in the delivery of care across the healthcare spectrum, will require more primary care physicians. Do we have the necessary resources to build this medical home? Time will tell....