Patient Centered Medical Home Summary

Pay-for-performance payment model – healthcare payment systems that offer financial rewards to providers who achieve, improve or excel their performance on specified quality of care and cost measures (HealthCare Incentives Improvement Institute, N.D.)

Partnering with Patients and Families to Design a Patient- and Family-Centered Health Care System: Recommendations and Promising Practices. Institute for health care improvement (2008). Retrieved October 15, 2015.

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.

The advantage of VBPS program is that it promotes and reimburses for all treatments that are planned to help to bring better health outcomes for Medicare patients. This program also plays a part in reducing the rate of unnecessary tests and referrals that are unrelated to treating of patients’ conditions. The program gives incentive rewards to healthcare facilities that are successful in reporting the high quality of cares and better patients’ health outcomes. It also serves as supports and guidelines for healthcare facilities to build needed infrastructures to improve their quality of services (Minemyer, 2016).

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.

Pay-for-performance programs are expected to expand across the United States health care in the near future, especially with the implementation of the Affordable Care Act. The pay-for-performance is going to continue to increase the quality of health care that the patient receives from their

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).

For anyone who has kept up with the news, the US healthcare system has undergone major changes in recent years. Insurance providers are no longer able to deny someone coverage based on pre-existing conditions. The advent of healthcare marketplaces has changed the way people purchase health insurance. Children can stay on their parents' health insurance plans until 26. Leading the healthcare revolution is InnovaCare Health. This organization is a leading provider of Medicaid and Medicare Advantage plans. InnovaCare Health recently announced it would partner with the Health Care Payment Learning and Action Network. This is a significant private-public partnership that seeks to change compensation models to reflect the quality of care instead of quantity. This new partnership reflects InnovaCare Health's to affect change in compensation sooner rather than later. The current healthcare model focuses on reimbursing physicians based on the number of patients seen or procedures performed. This encourages "treadmill medicine," or a model that focuses on rapid turnover. This can often lead to detrimental effects on patient health. The new quality model would reward physicians based on practice targets. Potential goals include HbA1c goals for patients with diabetes, the percentage of patients who smoke, and hospital stay after surgical procedures.

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 medical home concept is not new, as it is built on health care practice innovations that have arisen over the past 40 years (Kilo & Wasson, 2010). From these principles, a multitude of medical home projects and demonstrations across the United States have grown (PCPCC, 2011). Given the unique characteristics of each of the numerous projects promoting the PCMH model, it is difficult to obtain generalizable evidence of the effectiveness of the model (van Hasselt, et. al., 2015). However, the most fundamental aspect of the medical home model—the primary care provider – can be the source of the effective functioning of the model, and its direct benefit to the Medicare-eligible population. The role of primary care within a health care system has been tied to health services’ costs, with some evidence supporting the idea that health care delivery systems that place an emphasis on primary care have lower overall health costs (Starfield & Shi, 2004). Although the medical home model is not just about primary care, it places a priority on this type of care as a critical aspect of patient care. As a result, evidence of the success of primary care can carry through to the PCMH model.

On February 2, 2016, the Patient-Centered Primary Care Collaborative (PCPCC) report highlighted 30 primary care PCMH initiatives that measured cost and utilization of services and concluded that PCMH reduces costs and improves health care quality. A senior vice president at the Blue Cross Blue Shield Association mentions that reduction in hospital admissions, emergency room visits and health care costs and

With new reforms being put in place under the Affordable Care Act such as the pay-for-performance (P4P) also known as “value-based purchasing,” which is intended to help provide maintain and efficient programs to improve health care cost. Healthcare providers, hospitals, medical groups, and physicians are offered incentives for meeting certain performance goals; it also fines for increased costs and medical errors such as incorrect medication or dosages. In two different studies quality of care was found to have improved at P4P hospitals compared to non-P4P hospitals Lindenauer et al. (2007) and Grossbart (2006). However, a study by Werner et al.(2011) found no continuing benefits in quality of care. One measure being advocated for is the Hospital Readmissions Reduction Program (HRRP) to prevent hospital readmissions as a way to improve the quality of care and at the same time cut cost. If patients are readmitted within 30 days after discharges due to conditions like acute myocardial infarction (AMI), heart failure, and pneumonia, fines can be levied such as 1 percent of Medicare payments. Others include the Hospital Value-Based Purchasing (VBP) is based on how well the hospital performs compared to other hospitals or the improvement of their own performance compared to a baseline time. The goal is to encourage better outcomes for patients and improve experience during hospital stays. And the Hospital-Acquired Condition (HAC) Reduction Program motivates hospitals to increase the safety of it patients by cut the number of hospital-acquired conditions and patient safety (Medicare.gov, n.d.) (Kruse, Polsky, Stuart, & Werner, 2012)(Gu et al.,

There are five core competencies needed for health care professionals and they are provide patient centered care, work in interdisciplinary teams, employ evidence based practice, apply quality improvement, and utilizing informatics. In this paper, I will go into further detail how providing patient centered care is challenging, how to overcome the challenges, how it relates to my chosen profession, and how this competency can impact delivery of care to patients.

Value base care rewards providers for working together to coordinate treatments, administrant the correct services, and improving overall population health. As time goes on, insurers will continue to base care provider reimbursements more on treatment quality than quantity.