The patient centered medical home (PCMH) model is a proven framework for the implementation of complex care through a patient-centered primary care approach. The NCQA, AHRQ, and CDC define PCMH implementations, collectively targeting better quality, access and lower costs for patients. The PCMH model has evolved overtime, although its primary applicability to the outpatient setting makes it hugely beneficial to all stakeholders involved in the delivery of comprehensive and coordinated care.
Geography: United States; Focus Area: State of implemetation of the medical home model
Definitions of the Patient Centered Medical Home (PCMH)
The definition of the patient-centered medical home has evolved overtime. According to the National Committee for Quality Assurance (NCQA), the model of a PCMH puts the patient at the core of the framework. A PCMH fosters effective relationships between the patients and their physician and care team. Outcomes of the PCMH include improved quality, patient experience, reduced healthcare costs and increased satisfaction of healthcare staff. The PCMH model reduces fragmentation in care delivery through teamwork, coordination, and communication, provides the means for better management of chronic conditions, and provides a better alignment with state and federal initiatives and payers. Organizations receiving recognition as PCMH are committed to patient-centered care and continuous quality improvement.
According to the Agency for Healthcare Research and Quality (AHRQ), a PCMH is a primary care organization and delivery model offering patient-centered comprehensive care, promoting accessible services, care coordination, safety, and quality.
In the definition by Centers for Disease Control and Prevention (CDC), the PCMH approach is focused on cost effective and high quality primary care. The key elements in this definition relate to culturally appropriate, patient centered care, delivered through a team-based approach, and care coordination across the health delivery system. The PCMH model offers increased provider and patient satisfaction, chronic disease management, preventive care, improved care quality, and cost savings.
Origins of the Patient Centered Medical Home (PCMH)
The joint principles of the PCMH were first defined in 2007 by the American Academy of Pediatrics (AAP), American Academy of Family physicians (AAFP), American Osteopathic Association (AOA), and American College of Physicians (ACP) as first contact, continuous, and comprehensive care by a personal physician, whole person orientation for patient healthcare needs, collective responsibility of care team led by physician for ongoing patient care, coordinated and integrated care across complex healthcare system, communities, registries, and health information exchange, in a manner that is linguistically and culturally appropriate. Other tenets of the PCMH include enhanced access to care, safety and quality, and value-added payment structure.
The origin of the PCMH originated in the specialty of pediatrics when children needed care for complex illnesses. Henceforth, PCMH concepts were applied to primary care and multiple other organizations. A PCMH is alternatively referred to as a medical home or advanced primary care practice. The first models of PCMH came to be known as Medical Home for children with special health care needs (CSHCN). The pediatric medical home was a source of information for the CSHCN, the former often involved in care coordination with a fragmented profile of providers and physicians. The term medical home was first used by the American Academy of Pediatrics (AAP) to resolve problems with fragmentation of care.
In highly developed countries, the development of PCMH led to superior outcomes, reduced costs, long-term person-centered care, and comprehensive and coordinated care. A higher ratio of primary care physicians (PCPs) was linked to more equity in care, lower costs, and high care quality. Further studies indicated that superior outcomes, improved quality, and reduced costs were the result of systematic delivery of primary care rather than higher PCP ratio.
Promotion: 2. the Patient - Centered Medical Home: Closing the Quality Gap: Revisiting the State of the Science (Evidence Report/Technology Assessment Number 208) Paperback – Import, 22 March 2013 by U. S. Department of Health and Human Services (Author), Agency for Healthcare Research and Quality (Author)
Beneficiaries of the Patient Centered Medical Home (PCMH)
Payers, health systems, patients, and physicians benefit by implementing the PCMH model of care. Low cost and high quality offers value for payers and patients. In addition to cost and quality benefits, patients also receive improved access and coordination of care. The PCMH model addresses key concerns of physicians including dissatisfaction and distress related to work-life balance, and burnout. Key changes in practice processes lead to higher physician satisfaction and retention. Empanelment by involving a community of patients is an integral aspect of PCMH, although it may be difficult to determine the demographics, chronic illness status, preventive measures, and follow-up care. Teamwork, delegation, standardized processes, accountability, and interdisciplinary training drive successful PCMHs. The financing of most PCMHs is guided by the Medicare Reform Law and CHIP Reauthorization Act of 2015 (MACRA).
Over the years, healthcare teams have attempted to implement the patient centered medical home (PCMH) across military care, emergency care, cardiovascular care, stroke and complex conditions to achieve coordinated, high quality, comprehensive care for diverse populations globally. The core principles of patient-centered care, team-based care coordination, and value-based services addresses complex patient needs through a robust model of primary care.
Promotion: A Retrospective Review of Patient Satisfaction: And the Relationship to Patient Centered Medical Home Paperback – Import, 17 June 2019 by Jacquelene S Hamer-McGhee (Author)
Keywords
patient centered medical home, patient satisfaction, NCQA, continuous quality improvement, CDC, coordinated care, comprehensive care, preventive care, AHRQ, PCMH, chronic care management, patient centered care
References
AHRQ. (2021). Defining the PCMH. Www.ahrq.gov. https://www.ahrq.gov/ncepcr/research/care-coordination/pcmh/define.html
American Academy of Family Physicians (AAFP), American Academy of Pediatrics (AAP), American College of Physicians (ACP), & American Osteopathic Association (AOA). (2007). Joint Principles of the Patient-Centered Medical Home. In AAFP. https://www.aafp.org/dam/AAFP/documents/practice_management/pcmh/initiatives/PCMHJoint.pdf
CDC. (2021). Patient-Centered Medical Home (PCMH) Model | cdc.gov. Centers for Disease Control and Prevention. https://www.cdc.gov/dhdsp/policy_resources/pcmh.htm
National Committee for Quality Assurance. (2011). Patient-Centered Medical Home (PCMH) - NCQA. NCQA. https://www.ncqa.org/programs/health-care-providers-practices/patient-centered-medical-home-pcmh
O’Dell, M. L. (2016). What is a Patient-Centered Medical Home? Missouri Medicine, 113(4), 301–304. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6139911/
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