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Patient Centered Medical Homes

SECTION ONE

1. Discuss the difference between Patient Centered Medical Home and Health Management Organization.
2. Explain why Health IT, workforce development, and payment reform are critical to success of Patient Centered Medical Home.

Useful Readings:

- Patient Centered Primary Care Collaborative (2010) Joint Principles of the Patient Centered Medical Home. Available at http://www.pcpcc.net/content/joint-principles-patient-centered-medical-home (Retrieved 08/21/2012)
- Patient Centered Primary Care Collaborative (2010) Introduction to the Patient Centered Medical Home. Available at http://www.pcpcc.net/content/emmi (video) (Retrieved 08/21/2012)

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SECTION TWO

Conduct some preliminary research on a Patient Centered Medical Home demonstration/pilot project in your state. The PCMH project can be a demonstration program initiated by your state government or by an insurance company. Please write a paper answering the following questions:
1. Which populations (e.g. adults, children, or elderly) and what conditions/diseases are targeted?
2. Who are the participating payers?
3. What type of insurance product (e.g. HMO or PPO) does the participating payers include?
4. Who are the participating providers? (Please just list the type of providers, such as hospitals or community health centers)
5. How are the participating providers reimbursed?
6. Please briefly describe the result and the progress of this PCMH program? (no more than 250 words)
7. What kind of payment method is more suitable for reimbursing PCMH? Justify your answer ( 1or 2 paragraphs)

Solution Preview

SECTION ONE

1. Discuss the difference between Patient Centered Medical Home and Health Management Organization.

Patient Centered Medical Home

The Patient Centered Medical Home is a new way of healthcare delivery in at the level of physician care. The primary goal is to coordinate care between providers under one physician to provide optimal care. Compared to the older Health Maintenance Organization, the control was with one provider but there was no management of care among the providers. The importance of health information technology is paramount in the new PCMH model along with training staff to be able to work with consumers, manage technology and coordinate patient care. Payment reform will be a critical point in the future to keep patients and providers happy with the new model.

The term "medical home" actually was determined in 1967 as the American Academy of Pediatrics began itself evolution toward a coordinated, family-centered approached to healthcare. There have been identified gaps in the way healthcare has been delivered. These interruptions have been sought to be corrected by a method called Patient Centered Medical Home (PCMH). The focus of this effort is in the area of the physician's network. The idea is to make the patient experience seamless and effortless. The patient experience is one of the most important aspects of changing systems. The provider is charged with making an alliance with the patients and
families to work to make modifications in their health and lifestyle. One of the premier agencies has gotten involved in making sure the PCMH model is regulated to meet standards across the health system (Martsolf, Alexander, Shi, Casalino, Rittenhouse, Scanlon, & Shortell, 2012).

The Joint Commission is well-known for putting their stamp of approval on hospitals across the nation if the meet their rigorous standards for quality. The same care has been put into developing this model for physician groups to follow to manage their patient care. Butcher (2012) defines the popularity of this model because it looks at the whole person. Many that have already been using the model have seen a significant decrease in the percentage of people in their practice that use the Emergency Department for primary visits. In a New Jersey healthcare consortium, there was a 21% lower use of inpatient care in the trial group compared to the PCMH counterparts.

The Joint Commission separates the principles into several subcategories. The first of these involve the practitioner. The physician must drive the experience by providing ongoing continuous care for the patient. It is important to be the leader of the team that is providing the care for the entire patient. The care of the patient can not be segmented such as in times when a patient would go to different providers for ailments and none would confer with each other. This often would lead to mistakes in diagnoses and interference of medications with each other. One provider in the PCMH knows everything about one patient making these serious errors less
likely (http://www.pcpcc.net/content/joint-principles-patient-centered-medical-home). Quality and safety is another effort of The Joint Commission. To be a part of this model is voluntary participation. Most practices are anxious for the designation, just as hospitals and eventually it may be mandatory for compensation. Patients are asked to be involved by giving feedback on care at the practice stage. Offices are more likely to have increased and different hours to accommodate their customers on this model (http://www.pcpcc.net/content/joint-principles-patient-centered-medical-home).

Health Maintenance Organizations

Among other requirements, ...

Solution Summary

The expert discusses the differences between patient centered medical home and health management organization. Why health IT, workforce development, and payment reform for critical success is examined.

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