What is a Patient Centered Medical Home?

  

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As defined by the Patient-Centered Primary Care Collaborative, a consortium of healthcare providers, insurers, and payers, “The Patient Centered Medical Home (PCMH) is a health care setting that facilitates partnerships between individual patients, their personal physicians, and when appropriate, the patient’s family.” It is a model of practice built upon a strong foundation of primary care.  It aims to improve the quality of care by coordinating the efforts of all of a patient’s health care providers.

Studies have shown that systems in which a primary provider orchestrates the various aspects of a patient’s care are more effective and less costly than those without such a design.   In fact, a lack of coordination and communication between providers is often cited to explain the finding that, broadly speaking, more medical care does not result in better health outcomes.[i]  In fact, the PCMH model has improved outcomes and lowered costs in various settings. Data from several PCMH interventions, published by the Patient-Centered Primary Care Collaborative, show decreases of up to 50% in ER visits and 24% in hospital admissions.  Johns Hopkins saw an annual net savings to Medicare of $1364 per patient.  Similar results have been seen in different populations, including children.

Defining principles for the PCMH model were established jointly in 2007 by four professional societies representing primary care physicians: the American Academy of Family Physicians (AAFP), American Academy of Pediatrics (AAP), American College of Physicians (ACP), and American Osteopathic Association (AOA).[ii]  Among these principles are:

·     Personal physician: “each patient has an ongoing relationship with a personal physician trained to provide first contact, continuous, and comprehensive care”; and

·     Whole person orientation: “the personal physician is responsible for . . . all the patient’s health care needs or taking responsibility for appropriately arranging care with other qualified professionals”.

The failed “gatekeeper” model employed by health maintenance organizations (HMOs) in the 1990s shared these noble aims.  However, the PCMH model has taken some lessons from the unpopular managed care experiment.  PCMH doctors do not stand between a patient and a specialist physician.  Primary care providers are not financially accountable for restricting the use of specialist services as they were under managed care. Patients are also free to choose their doctors, and not restricted to a pre-approved panel of providers. The primary care physician’s role is to facilitate communication of a patient’s medical history to the specialist, and to integrate information from the patient’s other providers into a comprehensive medical record.[iii]

The PCMH model was designed to be just that—patient-centered.  Its conceptual framework and success may ultimately derive from the attention paid to patients’ needs.  Many are optimistic about its potential to improve the quality of healthcare while lowering its costs.  It is currently being implemented in many states and healthcare systems throughout the country—including Massachusetts.