Date
December 14, 2010
As the concept of today’s patient-centered medical home (PCMH) evolves, Ms. O’Kane highlighted the importance of (1) better aligning provider payments to emphasize high-quality outcomes for patients and (2) investing in a broader health care team to improve care.
Driving much of the activity around quality improvement is the imperative to contain costs. “We don’t have a choice about cost containment,” said Ms. O’Kane. “The question is not whether but how we do it.”
Each state may address health care costs and quality differently; models must be flexible to allow states and communities to be responsive to local conditions. Clearly, though, the patient-centered medical home model is one that is being embraced in communities across the country.
In New York State, numerous patient-centered medical home pilots that have been introduced. The Adirondack Region Medical Home Pilot, for example—one of the nation’s first multi-system, region-wide medical home demonstrations—comprises 12 health centers, five hospitals, and seven commercial insurers, along with Medicaid. All of those players are working together to ensure coordinated, high-quality patient care by preventing illness; helping patients manage chronic conditions like diabetes and asthma; using electronic medical records; embracing electronic prescribing of medications; and reducing unnecessary hospital readmissions. To be recognized and reimbursed, participants must meet measurable standards of patient care.
What does the patient-centered medical home model mean for patients? Ms. O’Kane described a series of focus groups held with patients in Pennsylvania, some of whom were part of a PCMH and others who were not. Non-PCMH patients in the focus groups were skeptical that a medical home could work in practice. However, the PCMH participants reported higher satisfaction with their care, suggesting that the model is in fact working. Patients noted the efficiency of paperless documentation during their interactions with health care providers; the ease of getting an appointment; and the effectiveness of the coordination of care for their multiple chronic health conditions. Even when these patients did not use the language of the “patient-centered medical home,” they noticed a difference in their care experience.
Achieving PCMH status is not easy; providers need to commit to change the way they organize and practice, including by embracing health information technology and a team-based approach to care.
The shifting health care landscape requires a broader health care team to meet patients’ needs. As the system continues to shift from a fee-for-service model to patient-centered medical homes and a bundled payment approach through Accountable Care Organizations, more opportunities are emerging for community health workers, diabetes educators, and other frontline workers to become a more formal part of the care team and to be reimbursed for their services. Additional investments in the health care workforce are also needed in the context of reforming the health care system and ensuring high-quality patient care. For example, the supply of physicians and nurses trained in quality improvement does not meet the demand for these services.
When asked about the future of patient-centered medical homes, Ms. O’Kane noted that, five years from now, she expects that patients will be demanding performance information, and that accountability for costs and spending will be trickier than in today’s system. Specifically at NCQA, Ms. O’Kane predicts more explicit connections between their disease-specific recognition programs (for example, the Diabetes Recognition Program) and their different levels of recognition for PCMH.
What will remain unchanged? The commitment to “take rhetoric and turn it into measurable standards” to improve patient care and outcomes while reducing health care costs.