Patient-Centered Medical Home Model: A Case Study

The role of nurse practitioner is valuable when discussing collaborative care. There are so many levels of care, so many health entities, and so many insurer criteria involved that it is instrumental to have a role that can work towards help bring all aspects together. In addition to diagnosing, treating, and managing care, the role of the nurse practitioner is to manage simple and episodic acute health issues along with chronic disease (Sangster-Gormley, Martin-Misener, & Burge, 2013). It is important to note that although this is a function of this role, nurse practitioners also practice from a holistic point of view which allows them to help manage patient conditions or wellness in a more complete fashion. This includes helping patients have access to care beyond primary and secondary care settings. This encourages nurse practitioners to work alongside other health care and allied health professions, and families to create an individualized plan for every patient (van

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

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.

In some areas of population health, technology in enhanced patient information is utilized to perform risk stratification to identify the high risk patients. These patient’s often have uncontrolled BP, diabetes with an HgbA1c over 9, COPD, etc. Once identified as high risk or potential high risk, these patients receive additional care or patient outreach to help manage their condition. Some organizations employee RN Health Coaches and Care Coordination teams to help these patients and identify gaps in care. The primary care physician assumes care of the patient along with striving for the patient to become active in their overall health thereby keeping them out of the hospital (Sanford, 2013). One enhanced area of population management is the PCMH model. PCMH practices increase patient’s engagement in shared decision making while providing compensation for care coordination, care management and medical consultation outside of traditional face-to-face visits (Berryman, Palmer, Kohl &Parham, 2013). A patient centered approach pushes for changes not only in the delivery of medicine but in traditional encounters. In addition, PCMH encourages increased access to the patient’s primary care physicians and improved patient satisfaction scores. PCMH and population health encourages providers to increase after hours care to decrease emergency department visits and/or hospitalizations. Thereby reducing cost and improving the patient’s

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

healthcare services.2,3 Taken together, these challenges place significant stress on the healthcare system, prompting system stakeholders

As the continued support grows the PCPCC, the health care sector is recognizing the role of the medical home model, Accountable Care Organizations(ACO), many entities are embracing the model and performing better. According to Center of Medicare and Medicaid, the medical home model shows that there is an improvement cost effectiveness, which helps practitioners deliver quality care and advanced approaches to care coordination, care teams, and chronic disease management. As evaluations of ACOs, integrated health systems, and the medical neighborhood continue, the Patient Center Medical Home will be essential to driving improvements in cost, quality, and outcomes. [3]

As the nation moves in the direction of practical application of the Patient Protection and Affordable Care Act, understanding the capability of change will require tremendous uplift of the American human services conveyance. Keeping that in mind, the new law looks to reinforce the country 's essential care establishment through upgraded repayment rates for suppliers and the utilization of imaginative conveyance models, for example, persistent focused medical homes. Evidences recommend that these methodologies can return considerable advantages to both patients and suppliers by expanding access to essential care administrations, decreasing regulatory limitations and loads, and encouraging coordination over the continuum of care (Davis,

The Triple Aim is large, and the obstacles are frightening. Supply-driven demand, new technologies, and physician-centric care are said to be among the biggest barriers. With little or no foreign competition to spur domestic change, physician-centric care is negatively affected. New technologies may have limited impact on outcomes. Despite these obstacles, a handful of healthcare leaders is challenging the U.S. health care market. According to Health Affair, innovations in primary care such as the medical home, as well as “Minute Clinics” and other retail health care providers are challenging the prevailing approach

Our healthcare system needs major restructuring. Major improvements needs to begin with "all health care organizations, professional groups, and private and public purchasers should adopt as their explicit purpose to continually reduce the burden of illness, injury, and disability, and to improve the health and functioning of the people of the United States", (Crossing the ……, 2001).

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.