Oct 3, 2018 in Medicine

            A primary care medical home is a physician/patient relationship-based primary health care setting with an orientation toward the individual, families, communities and populations. It is also referred to as the Patient-centered medical home (PCMH). Kurt, et. al, (2010) defined the patient-centered medical home as “a team of people involved in the community who want to improve the health and healing of people of the community”. Coordinating with patients and their families requires a great deal of understanding and respecting each patient’s unique needs, values, cultures and preferences”. A medical home practice actively aids patients in learning to manage and organize their own healthcare at the intensity a patient chooses.

            The family practice physician group purchased by GMU shall therefore have the responsibility of providing the primary health care for the students, employee and their families, and the community at large. Primary health care services, as defined by Ontario Family Heath Team (2009) include: “health assessments, diagnosis and treatment, primary reproductive care, primary mental health care, primary palliative care, patient education and preventive care, and Telephone Health Advisory Service (THAS)”. In addition, some Family practice groups “may provide specialist services, diagnostic services and/or health promotion programs, chronic disease management and rehabilitation services” (Family Health Team, 2009). The physician group, however, cannot operate in isolation, hence the need for a well structured institution or system that can facilitate their operation. A primary care medical home is therefore developed under the health care model which includes individuals, the families, primary care physician group, hospitalists, case managers and social workers. Other stakeholders or partners like an insurance company and other corporate groups are necessary since the investments are important for enabling the functional relationships within the PCMH (Kurt, et. al, 2010).

          The establishment of a Primary Care Medical Home comes with lots of benefits. GMU employees and their families shall have a better health outcome on a variety of measures instead of with specialist which results in a higher per capita costs and lower quality. The (Strenger, 2007) explains that “Patients with primary care physicians as their regular source of care have lower health care costs than those who list specialists as their regular source of care”. Also the improved access to primary care shall “result in the decreased hospitalization rates for ambulatory care sensitive conditions” (Strenger, 2007). Identifying that patients and families are core of the care team, a medical home practice ensures a fully informed partnership in establishing care plans. This way, physicians can meet the “unique needs, culture, value and preferences” (AHRQ, 2011) of their patients.

Developing PCMH within the Family Practice Cooperate Structure

            GMU family practice, in the development of a Primary Care Medical Home would have the responsibility of providing a personalized care plan that focuses on the lifestyle and unique medical needs of its consumers. As stated earlier, this calls for a partnership between bodies like the patient, physician group, hospitalists, case managers, social workers, and other financial agencies like an insurance company. To successfully develop the healthcare home in a family practice, the following steps should be considered.

  • Developing “a standard definition of medical home and standard measures to determine whether the primary care providers meet this definition. This definition should be broad enough to allow for innovation and encompass various models that provide medical home services to their patients” (Strenger, 2007). This will be much achieved by collaborating with other purchasers of the health care in developing a uniform set of standards and common measures of the clinical performance outcomes. Current medical home definitions and metrics include the NCQA, PCC and Medical Home Index.
  • Organizing lessons from current demonstrations of medical home models and encouraging more demonstrations. Consideration should be given to the specific support for demonstration projects targeted at both small practices and rural providers and at high need or vulnerable populations.
  • Developing “a sustainable financing model that supports medical home services. Such a model could be based on the results of local demonstration projects or other national models” (Strenger, 2007). It should, however, be emphasized that the values of the primary care of the population are counted by the level of patients and population, where the costs are at the levels of enabling systems and practice. (Kurt. et.al, 2011). The financing model ought to see the importance of assessing the multi level effects and various perspectives. (Kurt. et.al, 2011).
  • Considering best ways to “provide an adequate funding for technical support, education and dissemination of best practices to support the patient-centered primary care practice re-design” (Strenger, 2007). “Investments are important for enabling the constructive relationships within the PCMH, between patients, community partners and the healthcare system.” (Kurt. et.al, 2011). “Primary care providers and health systems are likely to need the specific assistance in the multiple areas (e.g. practice redesign, staff training, and understanding new payment structures) as they work to implement the medical home model” (Strenger, 2007).

Objective of Primary Care Medical Home

A Primary Care Medical Home is responsible for the provision of a personalized care plan that focuses on the lifestyle and unique medical needs of its consumers. To achieve this goal, the PCMH has the following objectives, which are patient oriented;

To provideevery patient with “an established and continuous relationship with a personal physician” (Strenger, 2007)

To provide a team-based and comprehensive care that will meet all the needs of patients such as; wellness and prevention, acute and chronic care”.  (AHRQ, 2011).

To provide a coordinated and well integrated care system across the complex healthcare sector and connect patients to medical and social resources.

To provide enhanced access to care “that meets patients’ needs and preferences, including the care provided after hours and by e-mail and telephone” (AHRQ, 2011).

To “focus on quality improvement and safety, through physician participation in the performance measurement and improvement efforts, use of clinical decision-support technology, and clinical standards and guidelines built on evidence-based medicine” (Strenger, 2007).

Family Practice Incentives and Financial Models

Incentives are necessary in every primary care medical home model as they offer the following benefits: family practice physicians can expand their activities to include the optimal primary care functions, reduce spending achieved through better disease management and invest in electronic medical records, or other infrastructure changes improving the quality and safety of care.

GMU Family physicians can benefit from number of incentives or be compensated through a number of payment models. These models are from Strenger’s, Medical Home model (2007):

Pay for performance– this is “based on the achievement of the specific clinical outcomes or benchmarks”. Example incentive: Annual bonus payment to providers for meeting a clinical outcome goal, such as a target immunization rate or percent of diabetics in good glycemic control.

Pay for process– this includes bonuses for meeting process benchmarks and indicators, rather than specific clinical outcomes. Example incentive: Annual bonus payment to providers for meeting a process goal, such as implementation of an electronic medical record (EMR) or maintaining a diabetic registry.

Comprehensive prospective payments– prospective payments could be given on a per-client basis, risk-adjusted for patient mix, to cover the full range of medical home services. Payments could include disbursement guidelines to require a certain practice structure, staffing level or other practice characteristic (e.g. EMR for every patient) to receive the full payment. Example incentive: Annual payment of $500 per enrolled patient for providing a predetermined package of the primary care services, with guidelines as to the appropriate level of service.

FFS reimbursement for non-reimbursed activities– billing codes could be created for activities other than face-to-face office visits, such as the case management, telephone and e-mail encounters, and group visits, to allow physicians and other providers to bill for these services.

One-time start-up grants/demonstrations and technical assistance– one-time payments and educational services could be provided by payers to assist providers, especially those in small or solo practices, with systems change.

Carved out case management and disease management services – health plan could sponsor case managers/disease managers assigned to specific providers and/or regions.

           “All of the models encourage the delivery of comprehensive primary health care to patients by offering physicians the ability to earn incentives, premiums and special payments in addition to their capitation/complement payment or salaries for providing the targeted services” (Family Health Team, 2009).

Measuring the Primary Care Medical Home

          GMU may want to find out whether association with an insurance company is successful in participating in the Medical home. According to Kurt, et.al, (2010), “the rationale and goals for measuring the PCMH are diverse, and includes… guiding reimbursement or investment”. From this, GMU would be able to determine if their participation in the PCMH with an insurance company is a success by developing “a standard definition of the medical home and standard measures to determine whether the primary care providers meet this definition” (Strenger, 2007).

The NCQA PPC-PCMH measure “assess 9 standards such as: communication and access, care management, registries and patient tracking, patient self-management support, advanced electronic communications, performance reporting and improvement, test tracking, electronic prescribing and referral tracking”  (Kurt et. al, 2010). This practice, for it to be patient friendly must take interest in “understanding better how to assess the patient-centeredness and experience as well as quality and cost outcomes”(Kurt, et.al, 2010).

Conclusion

The provision of a primary care medical home allows a better access to health care and increases satisfaction with care. The medical home is a coordinated structure that operates based on partnership, not only between physicians and patients, but cooperate bodies, financing agencies and the government and other stakeholders.

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