The PCMH: A model for primary care

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                                                  Clinical Watch
                   F R O M C S A C , T H E C L I N I C A L A N D S C I E N T I F I C A F FA I R S C O U N C I L O F T H E A A PA

      The PCMH:                                     of the Patient-Centered Medical Home
                                                    in 2007, which were adopted by the
                                                    AAPA in 2008 as a means to improve
                                                                                                   comes. Information technology is used
                                                                                                   to support patient care, communication,
                                                                                                   and outcomes assessment.
      A model for                                   the quality of patient care.7 AAPA be-
                                                    lieves these principles can apply to any
                                                                                                      Access to care is expanded via ex-
                                                                                                   tended office hours and through alter-
                                                    setting where continuing, longitudinal         native methods of communication,
      primary care                                  care is provided.8,9 The principles of the
                                                    PCMH include the following:
                                                                                                   such as the Web or e-mail.
                                                                                                      The payment structure reflects
                                                       Each patient has an ongoing relation-       patient-oriented activities that continue
      ›WHO SHOULD READ THIS?                        ship with a personal physician. In some        outside the examination room, such as
      All physician assistants who provide          state demonstration projects, the per-         coordination of care, and provides ad-
      primary care.                                 sonal physician can be a physician as-         ditional reimbursement for providers
                                                    sistant and/or nurse practitioner.             with measurable improvements in pa-
      ›WHY IS THIS IMPORTANT?                          The personal physician leads a team         tient care and/or outcomes.7
      Health care providers currently oper-         of health care providers who take                 The Centers for Medicare and
      ate within a volume-driven system1            responsibility for the ongoing care of         Medicaid Services developed PCMH
      that provides disjointed and high-cost        the patient.                                   pilot projects in 400 practices in 2009,
      care.2,3 There is a continuing call for          The physician provides for all of the       and an additional 22 demonstration
      improvements in payment structure,            patient’s health care needs, at all stages     projects are under way in 14 states.3
      patient care quality, and patient out-        of life, or for coordinating care with         The current model of reimbursement
      comes. The call for reform is support-        other health care providers.                   in the PCMH integrates fee-for-service,
      ed by research that shows patients with          Care of the patient is coordinated          pay-for-performance, and reimburse-
      no usual source of care incur higher          across the health care system and the          ment for coordination of patient care.
      health care costs and have poorer             patient’s community.                           This system provides compensation for
      health outcomes.4                                Quality and safety are at the core of       services that take place outside the pa-
        The concept of the patient-centered         the medical home. Patients are partners        tient examination room with financial
      medical home (PCMH) was devel-                with the physician. Evidence-based             recognition that is reflective of patient-
      oped by primary care physicians and           medicine guides decision making, and           case complexity.3
      large employers to encourage compre-          physician groups participate in perform-
      hensive health care, improve patient          ance measurement to assess patient out-        ›WHAT’S NEW?
      outcomes, and lower medical costs.5                                                          An updated PCMH model emphasizes
      The PCMH approach provides com-                                                              the multidisciplinary team, with PAs
      prehensive care in a setting that facili-      TAKE-HOME POINTS                              and nurse practitioners as partners and
      tates a partnership with the patient, via      ■ The concept of the patient-centered         advisors.10 Recent health care reform
      an interdisciplinary healthcare team              medical home (PCMH) was developed          legislation introduced to the House of
                                                        by primary care physicians and large
      and community resources.2,6 The cur-                                                         Representatives (HR 2350) and the
                                                        employers to encourage comprehen-
      rent goals of the PCMH include pro-               sive health care, improved patient
                                                                                                   Senate (S 117411) would fully integrate
      viding high-quality preventive care and           outcomes, and lower medical costs.         and recognize PAs as principle primary
      effective chronic disease management           ■ Patients in states with a g
Description: The call for reform is supported by research that shows patients with no usual source of care incur higher health care costs and have poorer health outcomes.4 The concept of the patient-centered medical home (PCMH) was developed by primary care physicians and large employers to encourage comprehensive health care, improve patient outcomes, and lower medical costs.5 The PCMH approach provides comprehensive care in a setting that facilitates a partnership with the patient, via an interdisciplinary healthcare team and community resources.2,6 The current goals of the PCMH include providing high-quality preventive care and effective chronic disease management across the life span and a reimbursement structure that includes coverage for coordination of care and documentation of patient outcomes.2 *WHAT ARE THE CURRENT RECOMMENDATIONS? Other challenges to the PCMH model include addressing the health care needs of patients without health insurance and/or inadequate insurance, patients with mental health and/or substance use issues, and patients from diverse backgrounds.4,5,17 Although the literature supports a positive correlation between contact with a primary care physician and demonstrated health benefits,5 evidence that instituting the PCMH will accomplish its stated goals in specific populations is limited, but recent data are positive.
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