The Future of Primary Care: Patient-Centered Medical Home

There has been growing consensus for the Patient-Centered Medical Home (PCMH) as a solution to containing healthcare costs and promoting high-quality patient-centered care. The PCMH is a model of primary care delivery which provides accessible, continuous, coordinated, and comprehensive services to patients. Many providers, especially those caring for low-income patients, will need substantial assistance to reach the standards and produce the measures needed to gain PCMH recognition.

The National Committee for Quality Assurance (NCQA) defines a medical home as a model of care that:

• Builds patient-provider relationships: physician practices will strengthen the physicianpatient relationship by replacing episodic and fragmented care that caters to sickness, with a model that seeks to provide preventive and coordinated healthcare.

• Emphasis on care teams: each patient will have an ongoing relationship with a personal physician who leads a care team that takes collective responsibility for patient care.

• Coordinates care across settings: the physicianled care team is responsible for providing all the patient's health care needs and, when needed, arranges for appropriate care with other qualified physicians.

• Enables patient-centered visits: enhances the delivery of care through open scheduling, expanded hours and communication between patients, physicians and staff.

• Utilizes technology to improve patient outcomes: PCMH encourages the use of Health Information Technology to improve patient communication (alerts via e-mail), care coordination (accessible electronic health records from the primary care provider to the cardiologist to the emergency room), performance reporting (monitoring and data collection for diabetes patients), and evidence-based guidelines for chronic conditions.

Recent Advancements

Since 2007, major developments have taken place in New York and beyond, signifying the importance of the concept overall, but most importantly, the opportunity for providers to increasingly adopt the elements and standards of the PCMH model in order to enhance the quality of care for their patients.

• Development of PCMH Standards and Guidelines. In 2008, NCQA launched new standards for PCMH recognition in partnership with the American Academy of Family Physicians (AAFP), the American Academy of Pediatrics (AAP), the American College of Physicians (ACP) an the American Osteopathic Association (AOA). Most recently, these four organizations along with the Primary Care Collaborative (PCPCC) have also developed a new set of guidelines for PCMH demonstration projects.

• Launch of Large-Scale Demonstration Projects. Many large health plans, as well as Medicare and Medicaid, are planning demonstration projects to learn more about how providers can become medical homes and the quality and cost advantages of doing so, including teh Adirondack Medical Home Demonstration Project in New York State, as well as projects in South Carolina led by BlueCross BlueShield, and the California Academy of Family Physicians. Additionally, in 2009, BlueCross BlueShield of Michigan announced plans to designate more than 300 practices and 1,000 physicians in its PCMH program, serving more than 2 million patients.

• Adoption of Performance-Based Reimbursements. In 2009, nine states established multipayer medical home initiatives as part of the State Children's Health Insurance Program (SCHIP) or their State Medicaid programs. Additionally, in January 2010, New York State will begin offering performance-based Medicaid reimbursements for providers that gain PCMH recognition.

Learn how the PCMH model guides PCDC's Performance Improvement services and enables providers to Become Medical Homes.