* The medical home or patient-centered medical home (PCMH) is a team based health care delivery model that is led by a physician, P.A., or N.P. that provides continuous and comprehensive medical care to obtain better health outcomes. * Its goal is to increase satisfaction with care, allow better access to health care, and improve health. * Care coordination is an important component to the PCMH, which requires: health information technology, and staff trained to provide coordinated care.
* The idea was created in 1967 when the phrase was mentioned by the American Academy of Pediatrics because they wanted to create a central information source for children, especially those with special needs. * It was envisioned to be a family-centered, comprehensive, continuous, and coordinated car, and in 2002 this definition was put to practice. * In 2002, a few national family medicine groups operationalized a medical home to transform and renew family medicine; it was found that every person should have a medical home for all of their conditions. * It was analyzed that the medical home decreased costs, increased quality, and decreased disparities in health. * The Joint Principles of the Patient-Centered Medical Home:
1. Personal Physician
2. Physician Directed Medical Practice
3. Whole Person Orientation
4. Care is Coordinated and/or Integrated
5. Quality and Safety
* Patients are to be included in their treatment plan and information technology must be utilized to ensure optimum patient care. * Payment reflects the add value of patients that are treated in a PCMH.
* In 2009, the first accreditation program was created for medical homes, which included an onsite survey and required that they had core standards of ambulatory organizations. * This onsite survey serve to all the professionals to directly observe the service provided. * The Accreditation Handbook for Ambulatory Care includes certain characteristics that define medical homes and their standards:
1. Relationship-Communication, cooperation, and caretaker.
2. Continuity of Care
3. Comprehensiveness of Care
* Besides accreditation there is a pilot Medical Home Certification Program, which includes an onsite survey to evaluate an organization to determine whether they meet the standards of the Accreditation Association of Ambulatory Health Care (AAAHC). * To receive Physician Practice Connections and Patient Centered Medical Home (PPC-PCMH) recognition must have following elements: * ELEMENT 1A: Access and communication processes – The practice has written processes for scheduling appointments and communicating with patients. * ELEMENT 2D: Organizing clinical data – The practice uses electronic or paper-based charting tools to organize and document clinical information. * ELEMENT 2E: Identifying important conditions
* ELEMENT 3A: Guidelines for important conditions – The practice must implement evidence-based guidelines for the three identified clinically important conditions. * ELEMENT 4B: Self management support – The practice works to facilitate self-management of care for patients with one of the three clinically important conditions. * ELEMENT 6A: Test tracking and follow-up – The practice works to improve effectiveness of care by managing the timely receipt of information on all tests and results. * ELEMENT 7A: Referral tracking – The practice seeks to improve effectiveness, timeliness and coordination of care by following through on critical consultations with other practitioners. * ELEMENT 8A: Measures of performance – The practice measures or receives performance data by physician or across the practice * ELEMENT 8C: Reporting to physicians – The practice reports on its performance on the factors in Elements 8A (NCQA) Scientific Evidence
* 2007 CDC found continuous primary care in a medical home was associated with higher rates of vaccinations for the respondents’ children * Having a medical home was associated with less difficulty accessing care after hours, improved flow of information across providers, a positive opinion about health care, fewer duplicate tests, and lower rates of medical errors * “improved quality, reduced errors, and increased satisfaction when patients identify with a primary care medical home.”
* In the medical home, the patient has open access to see whatever physician they choose and the PCP has comprehensive knowledge and gives info to subspecialists. The managed care gatekeeper model (employed by HMO’s) places greater financial risk on the physicians thereby encouraging less care. * Other cons = increased operating costs, concerns over restrictions to optometry and psychology
Ongoing Medical Home Projects
* Community Care of NC–14 community health networks that link approximately 750,000 patients to medical homes, funded by Medicaid * RI Chronic Care Sustainability Initiative–Thirteen primary care sites, 66 providers, 68,000 patients, 100% payer participation, receive a supplemental per-member-per-month payment from all of Rhode Island’s insurers * About 26 projects still evaluating medical home concepts in 18 states
Role of PCMH and Accountable Care Organizations in Coordination of Patient Care
* 4 core functions of primary care = providing “accessible, comprehensive, longitudinal, and coordinated care in the context of families and community * PCMH model = integration of diverse services that a patient may need * ACO’s build on integrated care that PCMHs provide by facilitating transitions and aligning necessary resources; also monitor health information systems to create incentives for higher levels of responsiveness
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