Primary Care for the 21st Century: About the PCMH

A medical home is characterized by every patient/family having a personal physician who provides first contact care, understands the health care needs of the patient/family, facilitates planned co-management across the lifespan, and has the resources and capacity to meet the patient/family needs.¹⁷ As TransforMED CEO Dr. Terry McGeeney described it, “everything that goes on in a practice is for the benefit of the patient, and the patient is central to all activities and decisions. However, the concept goes much further than this. It implies trust, respect, shared decision making, cultural sensitivity, mindful communication in the exam room, whole-person orientation, and a continuous relationship over time. These are the strengths—the core values of family medicine.”¹⁸

Patient-centered care offers a full array of health care services using a team-based approach. This includes delivering care for all stages and ages of life, acute care, chronic care, behavioral and mental health care, preventive services, and end-of-life care. It also includes coordinating and/or integrating care for services not provided by the PCMH across all elements of the complex health care system (e.g., subspecialty care, hospitals, home health agencies, nursing homes) and the patient community (e.g., family, public, and private community-based services).¹⁹

In short, the PCMH model is a win-win for the patient because it:

Bringing down the cost of care. The cost of health care continues to be a major hurdle for our nation. While there is no silver bullet, there is growing evidence that the PCMH model—which emphasizes improved access to more robust primary care teams—can reduce total costs. A recent report by the Patient-Centered Primary Care Collaborative provides 34 examples of private insurance companies, and state and federal entities implementing the PCMH model and finding that “outcomes of better health, better care and lower costs are being achieved.”²¹ It also found that, “major insurers are driving primary care transformation through payments for patient-centered services nationwide as a means to increase access to care, control costs, improve patient satisfaction and make Americans healthier.”²² BlueCross BlueShield has tested the cost savings of the PCMH model and their first-year results showed “nearly 60 percent of eligible PCMH groups recorded lower than expected health care costs.”²³ The CareFirst BlueCross BlueShield president and CEO, Chet Burrell, said, “The program demonstrates to primary care providers that we recognize the critical role they can play in improving care and meaningfully reducing costs over the long term.”²⁴ In regions across the United States, outcomes from the PCMH model have shown reductions in emergency room visits, decreases in hospital admissions, and fewer total hospital inpatient days.²⁵
 
The PCMH Team. Health professionals share a common goal of providing high-quality, patient-centered, and team-based care that improves the health status of those they serve. The reorganization of care to a PCMH model puts primary care in the center of the health care system with doctors, nurse practitioners, physician assistants, nurses, and other health care professionals working side by side to care for patients. It draws on a team and uses the specific training and strengths of each member. For example, family physicians are trained to make complex diagnoses, often when a patient presents confusing symptoms. Nurse practitioners, on the other hand, are specifically trained to follow through on the treatment of a patient after a diagnosis and to implement protocols for chronic disease management.

Leadership is required in a medical home just as it is required in businesses, governments, schools, athletics, and other organizations. Just as every American
should have a primary care doctor, every medical home must have a physician serving as a leader who brings the highest level of training and preparation to guide the integrated, multi-disciplinary team. Delivering on this promise of a PCMH means it will be increasingly difficult for a health care professional to work alone. With each professional playing his or her specific role, the interdisciplinary PCMH team can deliver the highest quality care with the greatest cost-effectiveness. But a patient-centered team approach is the key.

Next: Meeting the Country’s Need for Primary Care Physicians