Monday, September 20, 2010

The Patient-Centered Medical Home: An Innovative Approach to Delivering Primary Care in Communities

With the enactment of President Obama’s health care reform legislation, much attention has been placed on the provisions affecting health care coverage. However, the delivery of pimary care services to children and families should be given equal attention. The Affordable Care Act calls for the creation of practice reform in primary care using Patient-Centered Medical Homes. Praised by its’ supporters as an innovative approach to delivering higher-quality, cost effective primary care, medical homes could potentially be adopted on a wider scale.

The term ‘medical home’ does not have one specific definition, instead there is an agreed upon set of principles behind the concept. Medical home refers to primary care that is "accessible, continuous, comprehensive, family-centered, coordinated, compassionate, and culturally effective.” Medical homes are not actually a physical place. The “medical home” approach refers to a coordination of services led by a primary care physician, who works closely with a patient's pharmacist, medical cost advisor, or specialist in order to improve the delivery of services. For example, a primary care physician team may use electronic health records (EHRs) to share medical history in real time with a patient's specialist. In 2008, more than half of all U.S adults report a lack of care coordination, such as a specialist not receiving basic information from their primary care provider and vice versa. Supporters, argue that this model will help to eliminate the problems often associated with primary care practices in the United States. Recent surveys have shown only 27 percent of adults in the United States can easily contact their primary care physician by telephone, obtain care or advice after hours, and schedule timely office visits. Further, an overwhelming 50 percent of patients report that they often do not understand what their primary care physicians have told them during office hours.

Currently, there are over 100 demonstration projects testing the patient-centered medical home approach. These approaches differ in each state. Community Care of North Carolina, a state-wide project to better coordinate care for high-cost Medicaid patients, has reduced hospitalization for asthma patients by 40% with state savings of $516 million per patient. Under the Affordable Care Act, the Centers for Medicare and Medicaid Services at the Department of Health and Human Services will continue to test medical homes among other new primary care-delivery models through demonstration project grants.

On August 17, 2010, HHS received state applications for the Multi-Payer Advanced Primary Care(APC) Initiative. More details on this opportunity can be found here.

Other Resources:
Can Patient-Centered Medical Homes Transform Health Care Delivery?, Common Wealth Fund
Patient-Centered Medical Home Collaborative Video, Patient Centered Primary Care Collaborative
Joint Principles of a Patient Centered Medical Home, Patient Centered Primary Care Collaborative
Health Policy Brief: Patient-Centered Medical Homes, Robert Wood Johnson Foundation

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