Patient Centered Medical Homes ( Pcmh )

The Patients served in CCO’s are covered by Medicaid, and benefit greatly from CCO programs with an emphasis on preventive medicine, chronic illness management and person-centered care (Oregon Health Authority). The number of patients served by CCO’s are unlimited, and can rise based on the needs of the community. The time frame for the work of the CCO is also a part of the quality measures. Although there is no strict framework for implementation as with ACO’s, there is still an urgency to implement and grow these programs quickly, while also maintaining high quality standards and goals such as the Triple Aim - improve health, lower cost, better care (Providence CCO Case

The fact that there are broad spectrums of services available within the Kaiser Permanente network makes it easier to coordinate patient care. For example the Northern California site has implemented programs that focus on five “imperatives of personal care”, which are: patients have to have a primary care doctor, they need to be able to see that physician, patients that call have a short telephone wait, patients should receive timely appointments and have a great care experience (Commonwealth fund June 2009). Care management definitely plays a crucial role in health care. When the patients needs are met and quality care is received the result is patient satisfaction and potentially cost saving for the organization. Patients not only have to deal with health issues, many experience challenges within their environment and certain limitations depending on socioeconomic status. Therefore , coordination of patient care is key to the success of any health care delivery system.

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,

The patient centered medical homes (“PCMH”) approach “focuses on keeping people well, managing chronic conditions like diabetes or asthma, and proactively meeting the needs of patients.” According to the Arkansas Department of Health, chronic diseases like cancer heart disease or diabetes affect approximately over fifty percent of adult Arkansans. Yet chronic diseases are often preventable. The high rate of chronic diseases can partly be attributed health insurance coverage—“when people don’t have health insurance they tend to avoid seeing doctors. People

Overview of the Patient Centered Medical Home project piloted by Geisinger Health System in Danville, Pennsylvania

Many chronic conditions can greatly affect an individual physically with some sort of chronic pain, mentally with depression, and socially by rendering them unable to work (Harris & Wallace, 2012). These effects can thus put strain on families and society as more individuals suffer from various chronic conditions. In recent years, many of those working as health care professionals, such as primary care providers (PCPs) are affected greatly by the widespread prevalence of chronic disease in the US. For PCPs, approximately 75% of their patients schedule visits for multiple chronic illnesses (Zamosky, 2013). This has caused a shift in health care to focus on tertiary prevention in limiting comorbidities and issues associated with chronic diseases. PCPs face challenges by having less time to treat chronic disease because they only having have approximately eighteen minutes to deal with on average seven issues for each patient (Zamosky, 2013). Since the Affordable Care Act (ACA) was implemented, insurance companies can no longer deny coverage or charge more for people with preexisting conditions which includes those with chronic diseases (ObamaCare Facts, n.d.). The ACA helps people with chronic illnesses to obtain insurance; however, since these people are insured

One of the aims of the Patient Protection and Affordable Care Act (ACA) of 2010 is improved integration and coordination of services for primary patient care. The patient-centered medical home (PCMH) is one of the approaches by which improvements can be established. The patient-centered medical home model is particularly well-suited for people who have chronic illness. The design of the patient-centered medical home model departs substantively from traditional reimbursement policies, in that, the ACA provides for incentives and resources to enable care coordinators to be directly recognized and compensated for their care coordination work. Care coordinators are most often registered nurses who through their work that aligns with ACA engage in quality improvement work, cost-effectiveness measures, and patient advocacy. To bring the ACA model to a human scale, the authors present a case study of a care coordinator at a patient-centered medical home in rural Maine. The table provided below provides a basic textual analysis of the study as it is published in the professional nursing journal.

The patient- centered medical home is designed to improve quality of care through a team-bases coordination of care, which would treat the majority of a patients needs at once by increasing access to care and empowering patients to be a part of their own care (U.S Department of Health and Human Services, 2014). In order for these homes to work, the authors suggest that specialists might be the best candidates to certain conditions, however for these specialist to function in the capacity that is needed in these medical homes, they would have to have interest and proficiency to manage other conditions that fall outside of their

The Patient-Centered Medical Home seeks to improve health system delivery through respect, coordination, and involvement of caregivers. The Patient-Centered Medical Home (PCMH) involves a team of nurses, legal consultants, pharmacists, therapists, insurance consultants, medical assistants, and physicians working together at one location to provide expert care in the health issues they are specialized to address. Team-based care is designed to make primary care meet the needs of patients by providing collaboration among medical professionals. Patient-centered care can potentially improve both clinical outcomes and satisfaction rates while improving quality of care and reducing costs (Rickert, 2012).

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).

The Affordable Health Care Act was designed to help Americans gain increased access to healthcare, improve the quality of healthcare, and decrease the overall cost of receiving health care. “The changing epidemiology of the nation and its impact on the cost of healthcare became one of the major drivers of healthcare reform in the United States,” (Mason et al., 2016, p. 275). Accountable care models were also introduced to improve the quality of healthcare and improve the costs of healthcare. In the primary care setting, it is difficult to maintain quality care for patients with chronic conditions. Many limitations to quality care include: decreased availability of team members, time management, and individual care planning. This has been

PCMH is an approach to providing comprehensive primary care to adults, youth and children. PCMH will broaden access to primary care, while enhancing care coordination. Its principles are collaborative care, patient- driven, utilization of a pharmacist, efficient, continuous care to acute, chronic, preventive, and end of life care, flexible, measurable outcomes, aligned payment policies.

The author has been employed in the healthcare field for over fifteen years that has allowed the time to observe the transformation of the primary care practice. This paper will examine the industry using Aspirus, Inc. as the reference point; however encompassing an examination of other healthcare institutions. Evidence suggests the Patient Centered Medical Home (PCHM) model, also known as the medical come, of care can offer many benefits, including improved quality in the patient experience and disease management and lower costs to the patient and system because of reduced emergency room visits or hospital admissions. The main objective of this paper is to highlight the challenges and explore what the PCMH model will be like in five years within the primary care setting of a healthcare organization.

The Affordable Care Act was a major healthcare reform centered on providing affordable health insurance coverage to all Americans regardless of their socioeconomic background or prior medical conditions. Under the Affordable Care Act, community health centers have been expanded to play an increasingly significant role in meeting the needs of the many newly insured individuals (Proser, Bysshe, Weaver, & Yee, 2015). Community health centers follow a unique model of care delivery that uses multiple primary healthcare team members, including PAs to increase capacity, reduce barriers to care, and improve patient outcomes while attempting to reduce the costs of care (Proser et al., 2015).

The current health care sector is too costly and too fragmented with a lot of variation in care even with established evidence based guidelines. Providers lack the tools, support and information they need to offer the coordinated health management that can reduce cost and improve outcomes. Primary Care Physicians are constrained in their abilities to perform any proactive care that involves avoiding Hospital or ER visits, and influencing healthy lifestyles.