¶ … medical home concept and describe the principles (operational characteristics mentioned above) of the PC-MH as defined by these organizations. How does this concept differ from the gatekeeper concept of Managed Care Organizations?
According to the 'gatekeeper' philosophy of health management organizations (HMOs), physicians are intentionally given incentives to reduce access to care. This is based upon the assumption that patients will want to obtain as much care as they can receive and physicians will want to bestow that care to please patients and incur more revenue. HMOs encourage physicians to do the opposite and often financially reward physicians for cost reductions and limiting access of patients to specialists or heroic treatments. In the HMO model, physicians try to restrict access to specialists when they do not deem it necessary.
In contrast, the medical home concept is viewed as a partnership between "individual patients, and their personal physicians, and when appropriate, the patient's family" (Joint principles, 2007, AAFP). In the PC-MH model, the physician is viewed responsible for arranging care to promote whole person wellness in a proactive fashion, including establishing connections with other physicians. Close communication between the patient, caregivers, and other members of the treatment team is vital. Instead of a gatekeeper, the PC-MH model views the primary care physician as a navigator of the healthcare environment. "The PCMH should ensure that the health care team pulls together to best serve patient needs in all arenas. In the PCMH, integration will have to be a system-property, with information systems, teams, and organizational linkages promoting integration" (Case for change, 2011, ADA).
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This is viewed in the PC-MH model not as a cost-reduction philosophy, but as part of a holistic, whole person orientation in which "each patient has an ongoing relationship with a personal physician trained to provide first contact, continuous and comprehensive care" (Joint principles, 2007, AAFP). The physician serves the patient and generates cost savings through directing care on a primary as well as a tertiary level. PC-MH is a "physician-directed medical practice -- the personal physician leads a team of individuals at the practice level who collectively take responsibility for the ongoing care of patients" (Joint principles, 2007, AAFP). Even when specialists are involved, care is integrated. "Care is facilitated by registries, information technology, health information exchange and other means to assure that patients get the indicated care when and where they need and want it in a culturally and linguistically appropriate manner" (Joint principles, 2007, AAFP). Throughout every phase of a patient's treatment, using these advances in technology, the primary care physician acts as a coordinator. Patients currently labor under the responsibility to coordinate their own care (and to fight with insurance companies when care is denied) despite being the "least trained in the complex culture and language of medicine" (Case for change, 2011, ADA).
Question 2-: The principles describe the advantages of a PC-MH. Describe the disadvantages of a PC-MC concept.
PC-MH does not necessarily improve access throughout the healthcare system to patients that…
