What is a Patient-Centered Medical Home (PCMH)?

Guest Blogger:  Wayne Hoffman, MD – Healthcare Consultant

Many of us grew up getting our health care through our family doctor or pediatrician – the doctor who knew everything about you and your family, and helped keep you healthy. He or she was the one you went to see no matter what was wrong with you, and for your annual check-up. Somewhere along the way we have lost that ideal. Health care now is fragmented, illness (not wellness) focused, expensive, and doesn’t always deliver the best outcomes. There is now an exciting new model of care that is beginning to sweep the country – the Patient-Centered Medical Home or PCMH. The term was first coined by Pediatricians in the 1960s, but has only recently been expanded to all of Primary Care. In 2007 the four main primary care organizations (American Academy of Family Physicians, American Academy of Pediatrics, American College of Physicians, and the American Osteopathic Association) got together and developed the joint principles of a PCMH:

  • Ongoing relationship with a personal physician
  • Physician-directed medical practice
  • Whole-person orientation
  • Care is coordinated and/or integrated
  • Quality and safety are hallmarks
  • Enhanced access to care
  • Payment appropriately recognizes the added value

Delivering on all of these principles requires a major culture shift for most practicing physicians – proactively managing your entire population of patients through a team-based approach to care. It requires the use of data, electronic communication with patients and specialists, and expanded access through extended hours and email.

Here, Georgia has made some tremendous progress in expanding access to Patient-Centered Medical Homes. The National Committee for Quality Assurance (NCQA) and Bridges to Excellence are two of the organizations that “recognize” practices as providing various levels of PCMH care. In 2010 Georgia only had 4 practices that had NCQA PCMH recognition. By May 2013, that number had increased to 69 practice sites and 329 providers, with more to come in 2014. The Georgia Academy of Family Physicians (GAFP), our state’s largest primary care provider organization, has taken the lead in transforming practices into a PCMH. The GAFP has set up a “PCMH University” with the mission to transform as many practices as possible to this improved model of care. Insurers in Georgia are beginning to recognize the added value of these enhanced PCMH practices. In 2013, WellCare began providing additional payments for NCQA-recognized PCMH practices, with other insurers considering enhanced PCMH payment programs in the near future.  (If you want to learn more about PCMH initiatives, I will be a panelist on the topic area tomorrow at the Healthcare IT Leadership Summit at the Fox Theatre and welcome other enthusiasts.)

Employers, providers, insurers, government, and patients are all behind this movement to a PCMH model of care. The evidence supporting this change is in: higher quality care; lower costs; and highly satisfied patients and providers.

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