The patient-centered medical home: Understand why and how it’s changing primary care

The first in an ISMA Reports series*

e-Reports, Nov. 19, 2012

Nationally, adoption of the patient-centered medical home (PCMH) has reached a “tipping point,” according to some analysts. Other states are moving faster, but odds are the pace in Indiana will pick up. And whether you’re in primary or specialty care, you’ll need to understand why and how the PCMH, an idea around since the 1960s, is now proliferating and changing medical practice.

In neighboring states, practices have made great strides to become PCMHs. NCQA recognizes more than 200 in Michigan and Ohio but only 21 to 60 in Indiana.

Committing the ISMA

However, as an ISMA member, you should know that Resolution 12-11, adopted by the 2012 House of Delegates, committed your organization to “support the Joint Principles of the Patient-Centered Medical Home as a guideline for states to improve the health of their citizens.”

The resolution also committed the ISMA to “encourage Medicaid and other payers to implement and fund programs that demonstrate the quality, safety, value and effectiveness of the patient-centered medical home, and to reward efficient programs.”

The Joint Principles were created in 2007 by the American Academy of Family Physicians, the American Academy of Pediatrics, the American College of Physicians and the American Osteopathic Association.

Bloomington ISMA Member Todd Rowland, M.D., was an author of the ISMA resolution.  He explained, "I have concerns that Michigan and Ohio have 10 times as many certified PCMH primary care practices as Indiana.  both these states have existing financial incentives for achieving certification from insurance companies and large employers. Physicians here may start feeling more pressure to become PCMH practices as large employers begin to require certification."

Defining PCMH

First, let’s be clear that the “medical home” is not a residence or even a medical facility. It’s a setting for health care delivery that involves a team approach with strong emphasis on coordination of care and enhanced access for continuous care. Electronic health records are an essential element, as well as heightened attention to quality and safety.

PCMHs need the backing of a significant entity, most often accountable care organizations (ACOs), payers or even large employers, to provide the resources needed. Numerous pilot projects are underway nationally, backed by both government and commercial payers.

PCMH practices that pay for certification agree the model takes work, as well as costly resources. Becoming a PCMH also requires commitment at every level of the organization – from the appointment scheduler, to the team leader physician, to the nurses who follow up to ensure patient compliance and successful referrals.

And PCMHs rely on technology. That means practices already striving to achieve meaningful use of electronic health records to earn incentive dollars are likely well on their way to being a PCMH.

*The next ISMA Reports will discuss the importance of the PCMH model, even to specialists and patients.

Agreed upon Joint Principles

The Patient-Centered Primary Care Collaborative (PCPCC), a non-profit charitable entity, was created to advance the Joint Principles agreed to in the ISMA resolution. Those PCMH principles are:

  • Personal physician - Each patient has an ongoing relationship with a personal physician for first contact, continuous and comprehensive care.
    Physician-directed medical practice – The personal physician leads a team of practice members who collectively take responsibility for the ongoing care of patients.
  • Whole person orientation – The personal physician takes responsibility for all the patient’s health care needs or for appropriately arranging care with other qualified professionals including acute and chronic care, preventive services and end-of-life care.
  • Care is coordinated and/or integrated across all elements of the complex health care system (e.g., subspecialty care, hospitals, home health agencies, nursing homes) and the patient’s community (e.g., family, public and private community-based services). Care is facilitated by registries, information technology, health information exchange and other means to assure patients get the indicated care when and where they need and want it in a culturally and linguistically appropriate manner.
  • Quality and safety are hallmarks of the medical home.

Learn more about PCPCC on their website.