Patient Centered Medical Home Summary

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.

· 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.)

A2a. Advantage and disadvantage of VBPS program 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).

Hederson, S., Princell, C. O., and Martin, S. (2012, December). The patient-centered medical home. American Journal of Nursing, 112(12), 54 59. doi: 10.1097/

Pay-for-Performance Pay-for-performance The pay-for-performance program will take health care from basic health care delivery to high-quality health care delivery. The way that this is going to affect the patient "customer" is because they are going to have an overall better experience with more attention to their overall health. The patient will also see benefits because there are incentives for patients when they live a healthy lifestyle. One of the incentives that the patient will see is in cost savings in the immediate future. Pay-for-performance is positive for all stakeholders involved within the program because it delivers on the main goal which is to increase the quality of care to patients while reducing the costs.

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

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.

Patient-Centered Medical Homes Roslyn Keller MHA628: Managed Care & Contractual Services Dr. Matthew Caines June 13, 2016 Patient-Centered Medical Homes Patient-centered medical home (PCMH) is a way to transform primary care practices into medical homes that coordinate care and communicate to what patients want to maximize health outcomes. Medical homes may lead to lower costs, higher quality care, improve patient experience of care, allow better access to health care and improve health.

Patient-Centred Medical Home Model 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.

Breakdown of participants including both Awardees and Episode Initiators by Models is as below: • Model 1 – 11 • Model 2 – 741 • Model 3 – 1353 • Model 4 – 10 CMS intends to work with BPCI participants to assess the effectiveness of the payment models on improvement of patient care and reduction of the healthcare costs. “All models include provider-led care redesign and enhancements, such as reengineered care pathways using evidence-based medicine, standardized operating protocols, improved care transitions, and care coordination. Awardee Agreements may also include proposals for gainsharing among provider partners.” (Center for Medicare and Medicaid Services,

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.,

The patient’s primary role in the Patient Centered Medical Home is to communicate his or her needs to the providers. Some common requirements of patients might be: to have someone available to answer any questions that arise about their condition, medication, or next steps in their care, assistance in scheduling appointments and coordinating transportation, someone to aid them with the understanding of insurance benefits, and someone to facilitate understanding of any medical conditions in order to allow them to

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.

Various elements influence how resources within a Patient-Centered Medical Home (PCMH) are managed. PCMHs veer away from traditional episodic and often fragmented care to offer patients higher quality care that is accessible, comprehensive, coordinated and more cost-effective. PCMH demonstration projects have shown that the model enhances health outcomes, reduces waste, and improves patient and employee satisfaction alike. This transition, however presents significant challenges and necessitates the restructuring of financial, material, and personnel resources within primary care structures. Effective implementation of this model is contingent upon the procurement of specialized staff, health information technology (HIT) systems, and possibly workspace reconfiguration all of which can impact an organization’s operating budget. Unfortunately, primary care payment reforms as well as complex billing and coding guidelines pose a significant threat to the financial viability of PCMHs and remain highly important factors to consider prior to undergoing this transition. Despite many of these challenges, PCMH continues to be a leading model in primary care. This paper presents a hypothetical PCMH implementation project and discusses some important considerations related to the management of financial, material, and personal resources.

Patient centered care is defined as “the practice of caring for patients (and their families) in ways that are meaningful and valuable to the individual patient, which includes listening to, informing and involving patients in their care” (Grenier and Knebel, 2003). Five challenges presented in patient centered care are patient obstacles, physician and practice obstacles, facility obstacles, community obstacles, and health literacy.