The Patient Center Medical Home

United States is the largest and most diverse society on the globe. It spends almost 2 trillion dollars every year on health care, which is one in every seven dollars in the economy. U.S is one of the very few nations where all its citizens do not have medical coverage. Although it spends heavily on per capita on health care, and it has the most advanced medical technology system in the world, still it is not the healthiest nation on earth. The system performs so poorly that it leaves 50 million without health coverage and millions more inadequately covered (Garson, 2010).

has the world’s most expensive healthcare system, yet one-sixth of Americans are uninsured. Approximately one-third (31%) of adults and a little more than one-half (54%) of children do not have a primary care doctor. Federal spending on healthcare in 2005 alone totaled $600 billion, a massive one-quarter of the federal budget. Someone files for bankruptcy every 30 seconds in the U.S of health concerns. And every 1.5 million families lose their homes to foreclosure due to unaffordable medical costs. The U.S. spends six times more per capita on the administration of the health insurance system than Western European nations, who insure all citizens.“ www.realtruth.org/articles/090203-005-health.html. “In United States, the annual cost of health care per capita is $5,711. http://www.visualeconomics.com/healthcare-costs-around-the-world_2010-03-01/#ixzz12f0I1lbk

The U.S. Health system spends a higher portion of its gross domestic product than any other country but ranks 37 out of 191 countries according to its performance.” (WHO, 2000, p. 1) Progression in the United States has not kept up with the advances in other wealthy nations dealing with the population health. Disease and chronic disability report almost 50% of America health problem (JAMA, 2013).

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.

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 United States has been slow in addressing the need for an effective primary care health care system either due to special interest groups or the lack of a political “window of opportunity” to take on this challenge. In January 2000, an article in JAMA,

The United States healthcare system has been the topic of much debate lately, with many propositions and reforms introduced to the public to remedy the many complaints made against the current system. The U.S. spend entirely too much money on health care. Based on data released by the World Health Organization (WHO), the "U.S. spent more on health care per capita ($4, 849) and more than 17 percent of its gross domestic product (GDP) to health care" (Squires, 2012).

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.

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.

The United States spends extremely highly on health care compared to the rest of the OECD members. For instance, the U.S. health care system spending per capita in 2006 was $6,714; the cost was over double the mean per capita spending of the OECD 30 industrialized countries, which was $2,880 (Anderson & Squires, 2010). Additionally, the U.S. health care system spending per capita was 50% higher compared to that of Norway; in 2006, Norway spent $4,520 (Anderson & Squires, 2010). Second, the health care expenditure in the USA in 2006 comprised of 15.3% of GDP, whereas in other OECD nations, it was largely less than ten percent and did not exceed

The current system of healthcare in America has a primary care division that is not well developed, strongly valued, or large in numbers compared to other OECD healthcare systems around

As of 2011, most of the U.S health care spending went to “hospital care at 32%, physician and clinical services at 20%, nursing home and home health care at 8%, Dental services at 4%, Other professional and personal health-care services at 3%, Government public health activities at 3%, Net cost of health insurance at 6%, Other medical products at 3%, Government administration at 1%, and Investment at 6%”; all these are the services that the U.S health care expenditure funds (Rice et al., 2013). Hospital care, Physician and clinical services, Nursing care facilities & continuing care retirement communities, and Drug

Patient-centered medical homes have been recently recognized by the Centers for Medicare and Medicaid Services and qualify as models of healthcare that have the aim of shifting care to be more patient-centered rather than disease-focused. Based on this definition, the PSH model should qualify in this category. Therefore, any cost constraints associated with the implementation of the PSH model can be offset using this method of reimbursement (Kain).

The Kaiser report suggested that healthcare expenditures in the United States comprised 17.9% of gross domestic product, equating to $8,402 spent on healthcare per person. The report further projects that by 2020, healthcare expenditures will be nearly one fifth of the U.S. economy. Though spending for the health care is one of the major part of country’s expenditure still the health care system is overwhelmed with rising costs and poor quality care. To establish quality care various institutions like the Joint Commission, the centers of Medicare and Medicaid, the National council of quality assurance etc. were framed.

According to the organization for economic cooperation and development (OECD), the United States spend 17.7% of its gross domestic product (GDP) on health in 2011 more than any other country in the world. The average expenditure for 34 developed countries is 9.3% of GDP, which is mean that the United States, is the leading country in health expenditure. The private expenditure represents almost 60% of the total health expenditure, which is higher than any country in the world. The expenditure itself is not the only issue now but total expenditure growth from one year to another since 1970s is much more than other countries.