Patient Centered Medical Homes

Joe Sagadraca Kindall Shedrick

Tquarius Showers Alex Skirbst

Comprehensive Integrated Coordinated Care

History

The patient – centered medical home (PCMH) approach originated from a model introduced in 1967 by the American Academy of Pediatrics.

This approach is currently defined as provision of comprehensive primary care that brings together the clinical team with the well- informed patients and their families.

What is PCMH?

Patient – centered primary care model of interdisciplinary team practice

Payment reform Increased utilization of information

technologies Increased patient access and

involvement (Berryman, Palmer, Kohl, &Parham, 2013.)

Positive Characteristics of PCMH

Expanded access Creation of effective care teams Better coordination of care across the

continuum Quality improvement Patient actively involved in healthcare Educating the patient and family

Collectively producing better and safer care while improving the experience of care for all

patients.

Current Issue

PCMH involves new costs ( EMRs, registries ) and some new and

unfamiliar staff and functions that are largely unaffordable to practices

without the necessary resources. The added costs need to be recognized and supported by purchasers and

payers.

Current Issue cont..

Physician payment Case mix adjustment

Medicare only pays for doctor contact, not for the extra care that is asked to be provided.

No coverage for extra services

Alternatives

Physicians could hire dietician and physical therapist within the practice instead of referring them so that they can receive more compensation.

Compensate physicians for maintaining good health and for referring specialty doctors.

Our solution

Create and objective scoring tool that will be used for capturing and keeping track of all expanded services that a physician does. Upon gathering enough information as to the excess work required of physicians better reformation can be done.

Impacts of Solution

Allows us to see how many excess services are being provided by

physicians

Allows us to develop a pay scale for the most frequent of the excess

services

Eventually, give the physicians sufficient pay for their services.

Conclusion

There would be more active participation from physician if they

are being compensated for the excess work.

References Arend, J., Tsang-Quinn, J., Levine, C., & Thomas, D. (2012). The Patient-Centered Medical Home: History,

Components, and Review of the Evidence. Mount Sinai Journal Of Medicine, 79(4), 433-450. doi:10.1002/msj.21326

Berryman,S. N., Palmer, S.P., Kohl, J.E., & Parham, J.S. (2013). Medical Home Model of Patient-Centered Health Care. MEDSURG Nursing, 22(3), 166-196

Croghan, T.W., Brown, J.D. Integrating mental health treatment into the Patient Centered Medical Home. (Prepared by Mathematica Policy Research under Contract No. HHSA290200 900019I TO2.) AHRQ Publication No. 10-0084- EF. Rockville, MD: Agency for Healthcare Research and Quality; June 2010.

Meyers D., Peikes D., Genevro J., Peterson G., Taylor E., Lake T., Smith K.,Grumbach K. The Roles of Patient-Centered Medical Homes and Accountable Care Organizations in Coordinating Patient Care. AHRQ Publication No. 11-M005-EF. Rockville, MD: Agency for Healthcare Research and Quality. December 2010.

Reid R., Fishman P., Yu O., Ross T., Tufano J., Soman M., Larson E. Patient-centered medical home demonstration: a prospective, quasi-experimental, before and after evaluation. American Journal of Managed Care. September 2009; 1;15(9):e71-87.

Stange, K. C. MD. Defining and Measuring the Patient-Centered Medical Home. Journal of General Internal Medicine. June 2010; 25(6): 601–612.

Zurovac J., Peikes D., Zutshi A., Brown R. Efficient Orthogonal Designs: Testing the Comparative Effectiveness of Alternative Ways of Implementing Patient-Centered Medical Home Models. Rockville, MD: Agency for Healthcare Research and Quality. February 2013. AHRQ Publication No. 13-0024-EF.