Team Based Patient Centered Care, Research Paper Example

Introduction

According to the American Academy of Family Physicians (AAFP) (2011), a Patient Centered Medical Home model is defined as the provision of comprehensive preventive and primary care which will facilitate improve health care quality and efficiency. Such a concept is purported to deliver higher value not only to patients, but also to the health care system as a whole.

In contrast to the current U.S. system, which rewards high-volume, over-specialized and inefficient care, the Patient Centered Medical Home model is premised on health care that has a strong primary care foundation, provides clear incentives for the highest quality and efficiency at the same time (AAFP, 2011).

This model according to (AAFP, 2011), has been designed by competent experts to improve the quality and cost-effectiveness of care for patients having chronic diseases as well as being a huge cost-driver in the present system. For prospective service seekers, the Patient Centered Medical Home Model will deliver a regular source of primary care, in conjunction with better health outcomes at significantly lower cost.

Our medical home model will also serve maximize the patient experience while in house, for example, will ensure patients enjoy enhanced access to care through open scheduling, expanded hours and new options for communication between patients, their personal physician, and practice staff as much as possible (AAFP, 2011).

The medical according to AAFP (2011) home is characterized by:

1. Our provision of better access to needed services
2. Better quality of care drive
3. Our strong and greater focus on prevention
4. Our ability to provide early identification and management of health problems (AAFP, 2011).

Our trade mark Patient Centered Medical Home model will exhibit according to AAFP (2011) seven core features:

1. Personal Physician
2. Physician Directed Medical Practice
3. Total Person Orientation Approach
4. Coordination and Integration of Care
5. Outstanding Quality and Safety features
6. Enhanced Access
7. Carefully Designed and Customer-friendly Appropriate Payment (AAFP, 2011)

This Patient Centered Medical Home Model is a new way of how cutting edge health care should be delivered and financed (AAFP, 2011).

What can the patient expect?

Patients entering the facility can expect the following services from a well organized Patient Centered Medical Home, according to AAFP (2011):

• Trusted personal physician
• Well trained and competent Physicians who provides, manages and facilitates care
• Excellent coordination  and integration of Care  across healthcare systems
• Greater availability and accessible of  medical services through increased hours and easier scheduling
• Assistance from a trusted resources in negotiating through what can be a complex system of care
• Access to greater and diverse quality of resources for enabling more-informed healthcare decisions to made.
• Delivery of care safely and with utmost effectiveness  and non-replicable compassion
• Statistically supported healthier outcomes
• Excellent patient motivation through better and enduring relationship with personal doctors and affordable health plan (AAFP, 2011).

What can the physician expect?

Better supported by health plans to deliver quality care to patients through a shift in incentives, able to more effectively provide wellness and preventative care, which can lead to better outcomes, fair compensation tied to the additional services provided in the PCMH model as well as reward for improved clinical outcomes (AAFP, 2011).

Are there benefits for society?

Employers can purchase healthcare based on value and potentially see cost savings associated with more efficient health care programs led by clinicians and their care teams’ stress the importance of wellness and prevention in creating healthier employees.

Promises of a more present and productive workforce and having a regular source of preventive and primary care is within a Medical Home Model will according to AAFP (2011), have:

1. Lower per person costs
2. Lower emergency room utilization
3. Allow fewer hospital admissions
4. Allow fewer unnecessary tests and procedures
5. Realize less illness and injury
6. Result in higher patient satisfaction (AAFP, 2011).

Historical Reviews of Related Studies

Ten years of experience at Group Health Cooperative of Puget Sound according to AAFP (2011), demonstrated the model can improve the quality and cost-effectiveness of care for patients with chronic diseases.

A 2004 study by Katherine Baicker and Amitabh Chandra, AAFP (2011) cited  showed that states and counties with more primary care physicians show more efficient and effective use of care, leading to lower overall health care spending.

Additionally, according to AAFP (2011), North Carolina evaluated a multi-year effort employing a patient centered primary care approach with many elements of medical home model. An external accounting suggests that North Carolina Medicaid saved $124 million over what it would have spent otherwise in 2006.

Other studies examining the experience in 18 wealthy Organization for Economic Cooperation and Development countries according to AAFP (2011), document that a strong primary care system and practice characteristics such as patient registries, continuity, coordination, and community orientation were associated with improved population health.

When a comprehensive review of 40 studies published in the Annals of Family Medicine addressing the relationship between interpersonal continuity and care outcomes was done, according to AAFP (2011), it was found that nearly 2/3rds of outcomes were significantly improved where patients had a strong and ongoing relationship with a primary care doctor.

Finally, according to AAFP (2011),  the Commonwealth Fund 2006 Health Care Quality Survey found that health care settings with features of a medical home that offer patients a regular source of care, enhanced access to physicians, and timely, well-organized care have the potential to eliminate disparities in terms of access to quality care among racial and ethnic minorities.

Success Criteria for Patient Centered Medical Home

In order to succeed AAFP, (2011) reports, the patient centered medical home requires reform of the payment system. Fundamentally, it means restructuring the payment system so in addition to paying for procedures and treatment of acute conditions;

1. Physicians are compensated for health promotion, disease prevention, and management.
2. The current financial disincentives toward adequate primary care will have to be eliminated, and a new financing system that rewards continuity, patient-centered care and accountability will be needed if the patient-centered medical home is to be realized (AAFP, 2011).

Health Reform

Health Reforms has been advanced by;

• President Barak Obama, speaking on Obama Health Care Reform says according to Hunsinger (2011),

“I support the concept of a patient-centered medical home, and as part of my health care plan, I will encourage and provide appropriate payment for providers who implement the medical home model, including physician-directed, interdisciplinary teams, care management and care coordination programs, quality assurance mechanisms, and health IT systems which collectively will help to improve care.”

• President Barack Obama (Hunsinger, 2011).

The June 19, 2009 the Chairmen of the three committees with jurisdiction over health policy in the U.S. House of Representatives unveiled their discussion draft for health care reform.  The draft would reduce out-of-control costs, improve choices and competition for consumers and expand access to quality, affordable health care for all Americans (National Academy for State Health Policy, 2008).

Included in this draft is language on the Patient Centered Medical Home (PCMH).  The draft bill includes funding of $350 million for PCMH pilot programs, which include Independent PCMHs and Community-based Medical Homes (Massachusetts Medical Home Information 2011).

‘The Secretary shall establish a medical home pilot program (in this section referred to as the ‘pilot program’) for the purpose of evaluating the feasibility and advisability of reimbursing qualified patient-centered medical homes for furnishing medical home services (as defined under subsection (b)(2)) to high need beneficiaries (as defined in subsection (b)(1)).’ (Massachusetts Medical Home Information 2011).

The Senate HELP Committee released the ‘Affordable Health Choices Act’ on June 9, 2009 outlining the committee’s option for health care reform.

• Section 212 of the draft legislation – ‘Grants to Establish Community Health Teams to Support a Medical Home Model’ stated that:
• The Secretary of HHS would establish a grant program to creating the “community health team which is community-based, multi disciplinary, inter-professional teams (on the model of medical home) to increase access to comprehensive coordinated care (Massachusetts Medical Home Information 2011).

Enhancing Health Care Workforce Education and Training

There is language in the bill also aimed to enhance health care workforce education and training in Family Medicine, General Internal Medicine, General Pediatrics, and Physician Assistantship by providing grants to develop and operate training programs, financial assistance of trainees and faculty, and faculty development in primary care and physician assistant programs (Massachusetts Medical Home Information, 2011).

This bill according to Massachusetts Medical Home Information (2011) would provide grants to establish maintain and improve academic units in primary care. Priority is given to programs that educate students in team-based approaches to care, including the patient-centered medical home. Authorization is set at $125 million.

The Senate Finance Committee according to Massachusetts Medical Home Information (2011) is working on its own health care reform legislation.  Their focus on primary care and the medical home model includes:

Primary Care Bonus Payment

Certain Medicare providers being eligible for a primary care services bonus payment of at least 5 percent over the fee schedule amount for providing certain evaluation and management services (Massachusetts Medical Home Information, 2011).

Chronic Care Management Innovation Center (CMIC)

The establishment of the CMIC at CMS for Medicare, by the Secretary of HHS for the purpose of testing and disseminating payment innovations that foster patient-centered care coordination; with advancing PCMH’s at the top of their list (Massachusetts Medical Home Information, 2011).

Potential Items

The Committee finally, according to Massachusetts Medical Home Information (2011), would also look to reimburse states that use the PCMH model in their Medicaid programs.

Massachusetts Medical History

The Council of Massachusetts Patients-Centered Medical Home Initiative was formed in June 2009 at the behest of the Secretary of Massachusetts Executive Office of Health and Human Services Judyann Bigby, according to the Massachusetts Patient-Centered Medical Initiative Council (2009). After several meetings the team assembled developed a framework for a multi layer Patient-Centered Medical Home initiative that will involve Massachusetts primary practices and commercial entities and Medicaid Payers, according MPCMHIC (2009).

Evolving from this robust start, several tears later the American Academy of Pediatrics, the American Academy of Family Practice, American College of Physicians and the American Osteopathic collectively called for an approach that can revolutionize primary care, according to MPCMHIC (2009).

Central to the approach initiated by this Joint Principle of Patient Centered Medical Home body was the proposal to address (a), the fragmented discontinuous care that was negatively impacting the status of health as well the rising cost, (b) the increasing prevalence of chronic diseases, (c) the sub-par management of chronic disease among patients so affected, and (d) the persistent shortage of primary care providers.

Based on the ideas presented the council and its subsequent recommendations, 8 pillars, namely practice design, consumer engagement, payer participation, incentive alignment, practice engagement, input from the Executive Office of Health, and the establishment of time frame were incorporated as foundation on which the organization will be built on going forward (MPCMHIC, 2009).

Massachusetts Health Care Reforms and Medical Home

According to the Massachusetts Special Commission on Health Care payment System (2009), there is a pressing need to transform primary care in Massachusetts, in spite of what other reforms may have occurred in the wider environment.

Reforms are attainable in Massachusetts Health Care Patient-Centered Medical Home, if the relevant authorities accept and implement the recommendations of the Patient –Centered Primary Care Collaborative, whose guidelines includes, collaboration and leadership, practice recognition, practice support, a reimbursement model, and the assessments and timely reporting of results generated across the 46 primary care practice selected for patient centered medical home projects across states, according to Patient –Centered Primary Care Collaborative (2007).

These broad guidelines are broken down into a total of 15 smaller subsections, to provide more implicit details regarding how specific strategies and tactics can be successfully implemented across the states of Massachusetts, and positively impact the health status, especially within the medical homes (Patient-Centered Primary Care Collaborative, 2009).

Reference

American Academy of Family Physicians (2011) Patient-Centered Medical Home (PCMH) American Academy of Family Physicians retrieved from http://www.aafp.org/online/en/home/membership/initiatives/pcmh.html, on 10/04/11

Hunsinger, D.A., (2011). Patient Aligned Care Joint Principles of Medical Home AAFP, AAP, AOA, ACP   VA Outpatient Clinic Retrieved from www.mentalhealth.va.gov/…/PACT_PCMHI_Presentation_DH_AUG , on 10/21/11

Massachusetts Patient-Centered Medical Home Initiative Council (MPCMHIC), (2009). Framework for Design and Implementation Retrieved from www.medicalhome.info.org/joint%20statement.pdf on 10/21/11

Massachusetts Special Commission on Health care Payment System, (2009). Recommendations of the Special Commission on Health Care Payment System Retrieved from http://www.mass.gov/?pageID=eohhs2modulechunk&L=5&L0=Home&L1=Government&L2=Special+Commissions+and+Initiatives&L3=Healthcare+Reform&L4=Massachusetts+Patient-  on 10/20/11

National Academy for State Health Policy (2008). The Big Picture: Focus of Health Reform Retrieved from www.pcpcc.net/files/july162009, on 1020/2011

The Patient Centered Medical Home (PCMH) (2007).  Guidelines for Patient Centered Medical Home (PCMH) Demonstration Projects Retrieved from http://www.pcpcc.net/content/guidelines-patient-centered-medical-home-pcmh-demonstration-projects , on 10/04/11