Patient-Centered Medical Homes

rganizing the delivery of health care around the needs of the patient may seem like a simple and obvious approach. In a system as complex as health care, however, little is simple. In fact, thirty years ago when the idea of “patient-centered care” first emerged as a return to the holistic roots of health care, it was swiftly dismissed by all but the most philosophically progressive providers as trivial, superficial, or unrealistic. Its defining characteristics of partnering with patients and families, of welcoming―even encouraging―their

Healthcare is often driven by consumers and insurance companies; there is strong pushes for insurance companies to start paying better through Patient Care Medical Homes (PCMH) or Accountable Care Organizations (ACO) rather than paying at a per-visit basis (Hamlin, 2015). With PCMH or ACOs payment is made on a continuum of care, encouraging the provider to be involved in all aspects affecting health of the patient (Derksen, & Whelan,

Patient-Centered Medical Homes (PCMH) are growing in popularity as the right thing to do improve patient care. PCMH are growing in popularity, as there is early evidence of their effectiveness (Egge, M. 2012). The PCMH concept has been widely promoted as a way to enhance primary care and deliver better care to patients with chronic conditions. This model of care has stimulated the attention of payers, Medicaid policy makers, physicians, and patient advocates, as it has the potential to address several of the limitations of the current healthcare system (Wang, J. et al 2014). Currently, primary care in the United States is focused on acute and episodic illness, it inadvertently limits comprehensive, coordinated, preventive and chronic care (Bleser, W. et al 2014). The PCMH address these limitations through organizing patient care, emphasizing team work, and coordinating data tracking (Bleser, W. et al 2014). A PCMH and HMO have some similarities but are markedly different.

As the shift for HCOs is made to a PCMH model, the financial aspect also has to make a transition to accommodate to the changes. In recent years, there have been implementations of different payment and reimbursement options, health insurance programs, and the establishment of the Affordable Care Act (ACA). Between May 2009 and April 2012, one of the initial PCMH pilot programs was conducted in Colorado, appropriately named The Colorado Multipayer Patient-Centered Medical Home Pilot. More than 100,000 patients within sixteen internal medicine practices participated in the experimental PCMH model, using six different health plans (Harbrecht & Latts, 2012).

Providing comprehensive care to patients requires a team of different providers which includes: social workers, care coordinators, nutritionists, educators and pharmacists. This meets the physical and mental health needs of the patient through a team based approach to care. As clinician providers they have to ensure that PCMH is effectively serving patients with complex health needs are met (Rich et al, 2012).

An Accountable Care Organization (ACO) is one example of these inter-professional models of care delivery. ACOs are structured so physicians, nurses and other health providers can collaborate and work together in the delivery of quality while also being cost-effective. ACOs may also involve home care institutions, medical homes and even hospitals (Hart, 2012). In addition to being cost-effective, an ACO may be eligible to receive incentives if they meet performance and quality standards (Haney, 2010). Their emphasis is on primary care, wellness and health prevention. Given the focus of such entities, ACOs have the potential to reduce health care costs by eliminating redundant care, preventing unneeded hospitalizations and needless trips to urgent or emergency care services by providing coordinated care. Lessening trips to urgent care facilities and eliminating hospital admissions arguably, is already a positive patient outcome. Advance Practice Nurses (APNs) such as, Nurse Practitioners have the opportunity to lead an ACO entity, especially in remote communities (Haney, 2010). Having APNs available, sick individuals can seek immediate assessment and primary treatment prior to seeing specialists. Managing symptoms early may prevent complications down the

In my opinion, patient-centered care should become a norm and not be restricted to PCMH initiatives. There are certain false beliefs like providing patient-centered care can be too costly but compassion, empathy doesn’t even cost a penny. In fact there’s no need to ask too many questions as the aim is to get patients to talk. Listening carefully and responding positively are simple things that health care organizations should focus on towards patient centered care. Along with patients, it’s also important to engage family and friends in care. Another belief is that providing patient-centered care is the job of nurses. Although it’s not a myth it is still not restricted only to nurses. It’s a complete organizational change. Some assume that sharing medical information is a violation of HIPAA. But, it is not, in fact it’s a patient right, recognized by both federal and state

The patient centered medial home also abbreviated as PCMH is a care delivery model. This model ensures that patient treatment is arranged by their primary physicians to make sure that they will receive the obligatory treatment care. It is imperative that the patient receive required treatment and care when is it suitable and at any timely given manner.

The patient-centered medical home (PCMH) is a way of organizing primary care that emphasizes care coordination and communication to transform primary care into "what patients want it to be" (NCQA, n.d.). Medical homes can lead to better quality and decreased costs, and can develop patients’ and providers’ experience of medical care. PCMH aims to transform the delivery of comprehensive care to children, adolescents, and adults. Through this model, providers seek to improve the quality, efficiency and effectiveness of care they provide by responding to the unique needs and preferences for each client. The main objective is to have a centralized health care setting that facilitates organizations between individual clients, and their own physicians, and the client’s family members. “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” (American College of Physicians, n.d.). Major primary care provider groups and the Patient-Centered Primary Care Collaborative (PCPCC) believe that the most effective way to re-align disbursement incentives to aid the PCMH would be to combine traditional fee-for-service for office visits with a three-part model that includes the following: a monthly care coordination payment, visit-based fee-for-service component, and performance-based component (American

Therefore
such
 companies
are
not
positioned
to
arrest
a
potential
hospitalization
with
care
provided
in
the
home.

 Disease
management
companies
typically
rely
on
behavioral
modification
techniques
and
training
that
 does
not
allow
them
to
actually
monitor
a
patient’s
current
health
status.

Behavioral
modification
 without
proactive
monitoring
and
intervention
has
proven
ineffective
for
disease
management
 companies
and
the
payor
sources
that
hire
them.

While
physician‐led
care
coordination
is
most
desired,
 physicians
cannot
afford
to
be
consultative
under
the
current
reimbursement
guidelines,
nor
are
there
 enough
of
them
to
do
so.

 
 The
solution
is
to
leverage
current
industries
that
have
the
infrastructure
to
coordinate
care,
the
 confidence
of
the
patient
to
better
ensure
patient
compliance
and
the
ability
to
deliver
the
care
where
 the
patient
wants
it:
in
the
home.
The
Care
Cycle
Management
industry
creates
value
for
the
patient
by
 combining
disease
management
with
care
delivery
for
effective
care
coordination
targeting
the
sickest
 patients
costing
the
healthcare
system
the
most
money.
 
 Proof
that
coordinated
care
is
working
can
be
seen
in
a
recent
study
published
about
the
success
of
 the
medical
home
model,
Proven
Health
Navigator
(PHN),
introduced
for
Medicare
Advantage
enrollees
 in
11
practices
owned
by
Geisinger
Health
Systems
(GHS),
an
integrated
health
care
system
in
 Pennsylvania.

The
medical
home
model

The health sector has been going through a transition with an aim to improve quality of care outcomes and reduce cost. Different care models have been implemented to meet these goals for example Continuity or Continuum of care, Nurse managed Health Clinics, Accountable Care Organizations (ACO), and Medical homes. The author discusses the different concepts of care and how they are influencing or will influence the shift of care from acute hospital care to community settings. The author will discuss input from colleagues in relation to this topic and the challenges in implementing these concepts.

Managed by the Agency for Healthcare Research and Quality (AHRQ), the “patient centered medical home” (PCMH) or “primary care medial home” is the country’s primary care system. The goal, aAccording to the AgencyAHRQ, the goal is to provide “high- quality, accessible, efficient health care for all Americans.” The mission of the medical home model is to “improve health care in Americans by transforming how primary care is organized and delivered.” However, this starts by defining what exactly a medical home is. —Iit i’s not necessarily just a physical place. It i’s also defined by the AHRQ as an organizational model that delivers the care. There are five elements of the PCMH.

For patients with multiple health concerns and medical challenges it can be disheartening to have to keep up with all of the trouble surrounding the maintenance of health care. There is a specialist for each diagnosis, along with visits to the primary care physician, several insurances, sharing paperwork and lab results. As if the health condition itself is not tough enough to live with, it is more complicated for the patient to have to be the middleman between all the individuals in charge of his care. For example, Jim has diabetes, and as a result of his diabetes not being properly maintained he has lost his leg to amputation. In addition to Jim’s diabetes he has high blood pressure and chronic asthma. Jim too has some other mental health concerns. Therefore, Jim has to see at least 4 physicians he receive wound care for his amputation and he needs breathing treatments for his asthma. This is why the future of managed care if important. Like other transformative healthcare initiatives, patient-centered medical home (PCMH) implementation requires substantial investments of time and resources.

Over the last several years, a wide variety of health care organizations have been facing tremendous challenges. This is because they are using different models that will impact the underlying quality of care and the focus of staff members. To determine the most effective approach, there will be an emphasis on a number of areas to include: examining the community model, identifying three categories, comparing this with nursing practices, contrasting these ideas to Mihaela Colea views and discussing the importance of advocacy projects. Together, these different elements will provide specific insights that will highlight the best practices for a modern day health care environment.

Health care reform advantages incorporating the implementation of medical homes, which are defined as a model of patient-centered, primary care that encourages a team-based effort in delivering patient care. A comprehensive quality of care typically directed by the primary care provider, is supplied to the patient and the care involves coordinated and informed decisions by an accessible care team. The organized care team focuses on the patient’s safety by acknowledging and informing all care providers in the health care system team who are typically directed by the primary care provider and include nurses, care technicians,