The Challenges Facing the Patient-Centered Medical Home Model, Essay Example

While not exactly new, the Patient-Centered Medical Home (PCMH) concept has been receiving increasing attention in recent years as more primary care providers transition to the PCMH model. Under the PCMH system, health care providers work as a team, with an emphasis on bringing the skills of all team members to bear for each patient as needed. One of the advantages of the PCMH model is in dealing with patients with chronic conditions. By taking a comprehensive, team-based approach, the management of chronic conditions can often be done in such a way that helps to avoid the need for hospitalizations, as the stronger quality of care at the primary care level obviates the need for many such expensive decisions made in response to acute problems (Larson, 2010). This approach can mean lower overall costs for insurance providers, providing an incentive to these providers to support the PCMH model.

In many typical primary-care settings, payment systems such as Medicare only offer reimbursements with specific restrictions, which limit options for patients. In the PCMH model, team-based decisions can be made, or consultations and discussions about individual treatment plans can be held about patient care without requiring the presence of the patient for every such discussion (Green et al, 2012). Payment reimbursements from insurance companies or Medicare must be adjusted to meet the structure of the PCMH model. Physicians do not have the same requirements to spend a specific amount of time with a patient, and the payments are made to the PCMH organization as a whole, which must them disburse the payments to team members accordingly (Green et al).

Disbursements are made to team members based on the work that they do; part of the challenge of PCMH model is to create a new organizational culture that emphasizes the value of this teamwork, lessening the emphasis on the top-down approach (Larkin, 2012). The concept is a work in progress that is still weighted towards patient volume; for the long-term success of the PCMH concept it will be necessary to shift towards a model that more greatly rewards improving and maintaining patient health (Green et al). Additionally, it is necessary for PCMH centers to develop payment and reimbursement structures that properly reward each team member, a process that can be challenging, given the lack of standardization in the PCMH structure.

In the PCMH model, team members conduct pre-appointment meetings, or “huddles,” wherein the individual team members discuss the patient’s needs, review their records, plan the activities for the appointment, and also update plans for the treatment of any long-term or chronic care needs (Green et al). Many PCMH centers develop positions such as a care coordinator; this staffer is tasked with delivering needed educational resources to patients, dealing with arranging follow-up care, and otherwise managing the big-picture aspects of each patient’s long-term care (Larkin). Paying the salary for such a staff member can be a challenge to the PCMH center, as insurance companies do not typically offer reimbursements for care coordinators (Green et al). As with many other aspects of the PCMH model, this problem must be dealt with in a way that best fits the needs of each center.

There is evidence that the PCMH model offers significant benefits for patients. By offering health care that seeks to avoid acute episodes by providing comprehensive and broad treatment plans, many patients can avoid expensive hospitalizations or other expensive responses to acute episodes (Larkin; Green et al). By lowering the number of expensive treatments, and by lowering the costs of managing chronic conditions, these savings can be shared among various components of the health care industry. These potential savings clearly make the PCMH model a potential means by which the overall costs of health care might be reduced for patients and providers, making it a worthy area for further exploration and research.

References

Green, Ellen et al. Lessons Learned from Implementing the Patient-Centered Medical Home. International Journal of Telemedicine and Applications.2012.

Larkin, Howard. Trustee. 65(3). March 2012. pp17-20

Larson, Eric B. the Patient-Centered Medical Home Movement. The Journal of the American Medical Association. 303(16). 28 April 2010. pp1644-1645.