The future of the PCMH effort at this point is considerably difficult to make speculation about. Although the core principles are generally established, these can obviously be translated in a number of ways. There is a significant amount of interpretation to be had in the development of the principles in any given health care environment. There are also differences in degrees of implementation that further complicate the issue. However, despite all of the debatable points about the PCMH model, it is certain that this will be included in the transformation of the United States health care reforms that will emerge in the immediate future.
Patient-Centered Medical Home
Medical Home
How the Patient-Centered Medical-Home reducing cost and improving quality and safety for patients.
The patient centered medical home is a platform that fills a need in the current healthcare system. The U.S. healthcare system has been plagued for quite some time with a trend of substantially rising healthcare costs as well as another trend of slipping quality standards. These two trends are argued to be a phenomenon that has emerged at least partly from poor planning and ineffective use of resources. One solution to some of these issues can be found in the patient-centered medical home (PCMH) model of primary care. This model has been developed with the coordination of long-term physician-patient relationships in mind. Developing these relationships further can not only reduce costs in unnecessary procedures that are the result of the missed opportunity for preventive care, but also have been shown to improve patient satisfaction. This analysis will provide an overview of background of the different models that are developing as well as some discussion about this model's future trajectory.
Background
A patient-centered medical home (PCMH) model resulted in reduced costs of care, unnecessary emergency room (ER) and hospital visits, and improved population health (Sullivan, 2014). In fact, the nation's largest companies, including names such as Boeing, IBM, Intel, Safeway, and Lockheed Martin, are leading initiatives that are grounded in the PCMH healthcare model (Nielsen, Olayiwola, Grundy, & Grumbach, 2014). The patient-centered medical home (PCMH) concept is "an approach to providing comprehensive primary care [in] a health care setting that facilitates partnerships between individual patients, the personal [provider and the medical home team], and when appropriate, the patient's family. (Christensen, et al., 2013)"
The U.S. spending on healthcare is approaching three trillion dollars annually and is currently representing close to twenty percent of the country's entire gross domestic product (GDP). This comes at a time in which a growing body of research has indicated that spending on primary care provides better healthcare outcomes at a significant price reduction (Nielsen, Olayiwola, Grundy, & Grumbach, 2014). Thus the higher quality primary care is considered as a key success factor for the future of the healthcare industry in the United States. Furthermore, understanding patients' experience of healthcare is critically important because if patients are not satisfied and engaged with their healthcare providers, the healthcare is unlikely to succeed in improving health (Kern, Dhopeshwarker, Edwards, & Kaushal, 2013).
The features among PCMH models are generally describe among a set of core principles however there are many different versions of the model. The concept was first introduced in 1967 by the American Academy of Pediatrics who aimed to further the care that children receive from their primary care physicians and from this point the PCMH model has been the subject of increasing attention from clinicians, health plans, employers, policymakers, and many consumer groups. A precise definition of PCMH continues to evolve as the model develops but the core principles include a patient-centered approach that is comprehensive, accessible, coordinated and committed to quality and safety (Nielsen, Olayiwola, Grundy, & Grumbach, 2014).
Three of the most prevalent models are those offered by the American Academy of Family Physicians, National Demonstration Project, and National Committee for Quality Assurance (NCQA). The AAFP, in conjunction with the American Academy of Pediatrics, the American Osteopathic Association, and the American College of Physicians, released its model of the PCMH in 2007 that includes the following seven components of a patient's medical home (Ewing, 2013): personal physician, physician-directed medical practice, whole-person orientation, coordinated care, quality and safety, enhanced access, and payment reform. The NDP was a two-year pilot program initiated in 2006 by TransforMED, a division of AAFP. By the end of the study, the NDP model grew to be more similar to the AAFP model and the nationally accepted guidelines for the PCMH; Its current version is based on three pillars: patient-centered care, a whole person, orientation, and a continuous patient -- physician relationship.
After analysis, the NCQA approach emerged as the recommended model due to its specificity and comprehensiveness; some research suggests that the PCMH, and specifically the NCQA model, can achieve both increases in quality and reductions in cost (Ewing, 2013). The NCQA model for PCMHs is reflected in the evaluation's requirements. Each practice is graded on aspects of care delivery in six recognition categories: enhancing access, identifying and managing populations, planning and managing care, providing self-care support and community resources, tracking and coordinating care, and measuring and improving performance. With all of the different versions of the model that are available, there is much debate about how the model will progress forward.
The Future of the PCMH
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