Patient-centered Medical Home
Learn how a neurologist can function as a medical home neighbor. Watch Neil A. Busis, MD, FAAN, discuss how neurologists can set up a specialty medical home. Read about a pilot medical home for MS care.
- What is Patient Centered Medical Home (PCMH)?
PCMH uses traditional care delivery model, enhanced by improved care coordination and communication, to improve outcomes for all patients, especially those with chronic diseases.
The model was designed for primary care, but recently has been extended to include some specialty care as well. It is most successful when incorporated into integrated health care delivery systems and accountable care organizations.
- What Constitutes PCMH?
According to the Agency for Healthcare Research and Quality (AHRQ), a medical home has five functions:
- Provides care that is patient-centered with a strong focus on a physician-patient relationship and active participation of patients and their families.
- Provides comprehensive care and is accountable for all of patients' health care needs.
- Coordinates care for its patients in all health care settings, including specialty care, hospitals, home care, and community services.
- Is accessible to patients, which includes shorter wait times for appointments and a possibility to contact physicians via phone or email.
- Is engaged in activities that improve quality of care such as using evidence-based medicine and shared decision making, as well as utilizing quality measures, including measures of patient's satisfaction.
The National Committee for Quality Assurance (NCQA) developed a set of standards in 2011, for becoming a patient centered medical home. However, there is no consensus on a PCMH definition and no standardized tool for identifying medical homes to include them in pilot demonstrations.
- What are specialist roles in PCMH?
Success of the PCMH model has been linked to collaboration between primary care physicians, specialists, and other providers within the so called "medical neighborhood."
In October 2010, the American College of Physicians (ACP) published a position paper on the medical home "neighbor," which highlights the important role of specialty practices within the PCMH model.
- How are PCMH Physicians Paid?
According to Merell and Berenson (2009), there are multiple approaches to structure medical home payments, including:
- Enhanced payments for evaluation and management services that are currently not paid for under traditional fee for service, including: non-face-to-face communication by phone, and e-mail and care coordination.
- Additional codes for medical home activities services, for which codes do not exist. For example, for services performed to facilitate transitions between different care settings.
- Per patient per month (capitation) medical home supplemental payments for non-encounter-based activities.
- A risk-adjusted, comprehensive per patient per month payments, instead of fee for service.
- PCMH History
In the 1960s, the American Academy of Pediatrics (AAP) originally introduced the concepts of PCMH to provide better care for children with special needs.
Later the concept was expanded and implemented by the American Academy of Family Physicians (AAFP) and the American College of Physicians (ACP).
The Accountable Care Act (ACA), signed into law in March 2010, introduced many policies to strengthen and reform primary care, among them testing patient-centered medical home models.
Since then, the Center for Medicare and Medicaid Innovation (created by the ACA) introduced new medical home initiatives.
- PCMH Tips
- Assess how you interact with PCPs and how you add value for select patients.
- Understand the roles and compensation structure before joining a neighborhood.
- Ensure sound quality measurement and feedback processes are in place.
- Consider whether you will function as the principal physician, consultant or a specialty PCMH.