The current trend of Patient-Centered Medical Homes (PCMH’s) seeks not only to lower the costs of healthcare but to improve patient outcomes; it is an important concept to understand in regards to the state of healthcare in America, and as of 2011, 41 out of the 50 states have made some progress towards the formation of PCMH’s (Kaye, N., Bauxbaum, J., & Takach, M., 2011, p. 12). Despite their name, PCMH’s are not a place but a concept, a method of healthcare delivery that “provides comprehensive and continuous medical care to patients with the goal of obtaining maximized health outcomes” (Wikipedia, 2013, p. 1). The PCMH has seven defined components: the personal physician to provide continuity of care, a physician-led team, whole person orientation, coordinated care, quality and safety, alternative scheduling arrangements, and payment reform (Goldberg & Kuzel, p. 303). This paper seeks to explore the development of PCMH’s in Virginia, focusing on methods of healthcare delivery, targeted populations and conditions, participating payers and reimbursement, and the effects of the development of the PCMH on healthcare in the state.
Virginia’s Efforts towards Establishing Patient-Centered Medical Homes
With assistance from the National Academy for State Health Policy, the state of Virginia is working on developing a PCMH program using rural, multi-site clinics (Kaye, N., Bauxbaum, J. & Takach, M, 2011, p. 20). One of the leaders in the development PCMH’s has been the Virginia Community Healthcare Association (VCHA); since 1980, this nonprofit organization has been running Community Health Centers (CHC’s), in some of the neediest and most under-served communities throughout Virginia (Virginia Community Healthcare Association, 2012, .p. 2). The point of these community centers is to provide primary care to anyone who needs it. Services include, but are not limited to, physician visits, laboratory and radiology services, preventative services like breast cancer screening, immunizations, case management, and referrals to specialists. (Virginia Community Healthcare Association, 2012, p. 3). Participating providers for this program include the community health centers themselves, but also can include other public and private providers, hospitals, nursing homes, pharmacies and local businesses within the community (Virginia Community Healthcare Association, 2012, p. 4). The program targets under-served and needy populations, but PCMH’s have proven effective for certain targeted diseases as well, including conditions such as asthma, diabetes, heart disease, breast and cervical cancer, and depression (Kaye, N. et. al., 2011, p. 4-5). The Virginia Community Healthcare Association is currently in the process of achieving PCMH status for all 110 of their community health centers (Virginia Community Healthcare Association, 2012, p. 5) and there is clinical evidence to show that the PCMH model has improved patient outcomes for all of the aforementioned conditions (Kaye, N., et. al., 2011, p. 5), as well as reducing the rates of hospitalization and the usage of emergency room services (Kaye. N., et. al., 2011, p. 7), all of which are good indicators of the positive effects that the PCMH’s are having on the state of health in Virginia.
Funding and Reimbursement for Patient-Centered Medical Homes
These centers, in the process of working towards PCMH status, receive federal funding under section 330 of the Public Health Services Act, which is administered by the US Department of Health and Human Services Bureau of Primary Healthcare (Virginia Community Healthcare Association, 2012, p. 6). Medicaid has been one of the leaders in encouraging states to develop PCMH’s and many states who have used this model also include patients from the Children’s Health Insurance Program (CHIP), to provide services to low-income children (Kaye, N. et. al., 2011, p. 8). Other participating payers in this program include private insurance, Medicare, other federal and state grants, foundations, and local fund-raising. (Virginia Community Healthcare Association, 2012, p. 6). When considered as an insurance product, the PCMH is similar in structure to an HMO; the difference, however, is that the PCMH seeks to help control costs through improved patient outcomes, especially for chronic (and potentially expensive) conditions like diabetes (Fowler & Kelly, 2012, p.1).
Reimbursement of providers for PCMH services tends to be very targeted. For instance, it is used to help encourage collaboration between primary care doctors and medical specialists; it is also to support the use of technologies like electronic health records and to “reward more capable and better-performing medical homes” (Kaye, N. et. al., 2011, p. 9). Thus, the funding and reimbursement are enacted in a way to continually improve the PCMH programs that have been set up.
In conclusion, it is easy to see why so many states are developing some form of the patient -centered medical home. At a time when the cost of healthcare has become so important to the economy, especially with an aging population, the PCMH is particularly attractive. This style of healthcare delivery emphasizes holistic, continuing care. It not only helps to slow the growth of healthcare costs, but improves patient outcomes for a variety of conditions, including heart disease and diabetes, two of the most common chronic conditions in America. An understanding of the structure and purpose of the PCHM, as well as the funding strategies and reimbursement for participating providers of the PCMH’s is crucial to understanding the trend in national healthcare towards this form of delivery.
Fowler, Wanda & Kelly, Ann. State Initiatives in Patient-Centered Medical Homes. The Council of State Governments. Retrieved from: http://knowledgecenter.csg.org/kc/content/state-initiatives-patient-centered-medical-homes
Goetz Goldberg, Debora & Kuzel, Anton. (2012). Elements of Patient-Centered Medical Home in Family Practices in Virginia. Annals of Family Medicine. 7 (4) 301-308
Kaye, N., Bauxbaum, J. & Takach, M. (2011). Building Medical Homes: Lessons from Eight States with Emerging Programs. National Academy for State Health Policy. Retrieved from: www.commonwealthfund.org/…/1569_Kaye_building_medical_homes
Virginia Community Healthcare Association. (2013). Patient-Centered Medical Home. Retrieved from: http://vacommunityhealth.org/pcmh
Wikipedia Online Encyclopedia. (2013). Medical Home Retrieved from: http://en.wikpedia.com/medicalhome