Why the Medical Home Matters
Monday, March 21, 2016
Why the Medical Home Matters
Chris Espersen, MSPH, Independent Consultant
Editor’s Note: Chris will present on Making Medical Home Meaningful at our Spring Conference.
Take a minute to think about a really great experience with healthcare, or a really bad one. This is what I would tell new hires during new employee orientation. We had integrated a Patient Centered Medical Home (PCMH) overview into orientation so that new team members could join us on the journey that we had already come so far on.
Everyone had a story. And there were more negative stories than positive ones.
The point was that we wanted to emulate the things that made us have a good experience, and we wanted to avoid being “that practice,” the one that provides bad customer service at minimum, and adverse clinical outcomes at worst. And all of the examples demonstrated one or more of the principles of medical home.
Patient centered medical home is not a new concept—it has been around since 1967. The American Academy of Pediatrics coined the term to describe practices that met a number of standards that enhanced the patient experience and involved them in care that was designed to holistically treat their needs. The reemergence of the medical home concept came just before 2000, and has gathered steam since the Affordable Care Act was signed into law in 2010. Communities and providers received funding and resources under the Act to improve care for all populations, including the underserved.
Cindy had been seeing one of our most beloved providers for 19 years. Dr. T. truly has a knack for forming relationships with patients, and works hard to achieve outcomes with all of them. But for 19 years he had been telling Cindy to quit smoking, and for 19 years she continued to light up. Enter the Nurse Care Manager, and within six months Cindy had quit smoking and is now working on other healthy habits. Our patients have a number of adverse social determinants of health—poverty, violence, incarceration of self or of family members, limited English proficiency—and not even a 30 minute visit can begin to scratch the surface on patient barriers to treatment. Especially when that visit is designed around documentation for traditional billing purposes. But having other team members, working to the top of their licenses, allows professionals to comprehensively discuss concerns with patients, and arrive at creative solutions to address health needs and involve the patient in designing their own health goals.
In 2008, 65 CHCs were involved in the Safety Net Medical Initiative so that they could better help patients like Cindy. These centers received a variety of resources, including funding, to transform into Medical Homes. In 2011 many Federally Qualified Health Centers, including ours, participated in the FQHC Advanced Primary Care Practice Demonstration, which gave a generous Per Member Per Month (PMPM) to practices with 200 or more Medicare enrollees to transform to medical homes, as evidenced by NCQA PCMH certification.
Programs like this have been critical to transformation, but are not always sustainable. Payment reform is what allows us to continue the team-based approaches to care that produce favorable patient outcomes instead of just checking documentation boxes for services performed. NASHP has produced many helpful policy resources over the years, and this map is particularly useful in keeping up with what your neighbors in contiguous states are doing as far as Medicaid payment reform regarding medical homes.
Medical home is not, and should not be treated as, a separate, time-limited project. Nor is it the end all, be all of healthcare transformation. Becoming a medical home is much like our own home—more than just the building or inhabitants, it is a feeling of being safe, protected, cared for, and nurtured. The same way we have to do renovations on our home, in our medical home we have to tweak and sometimes even gut processes and start over. Life changes over time, and we have to adjust what we do to sustain good experiences and feelings, the essence of being at home. We also need to be very aware of the political, economic and social environment around us and be prepared for additional transformation opportunities and requirements.
Academy Health has conducted extensive research on our health system and, along with its partners, has reported on the return on investment for the medical home model (Bailit Health Purchasing, The ROI for Patient-Centered Medical Home Payment). As CHC medical homes, we must not only continue to transform our practices, but also be advocates for our patients, and demonstrate to payers and policymakers the continued need for appropriate payment reform.
The topics we will cover at the Spring Conference range from the technical “how-to-build-it” work plans to the heart of engaging staff and patients.
Expanded care team members such as Nurse Care Managers, Behavioral Health Consultants, and Family Support Workers (care coordinators) help patients meet goals that matter to them.
Family and loved ones: why becoming a medical home is so important
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