Making a PCMH “Feel Like Home”
William Appelgate, PhD, CPC
Health care reform is shaping new ways that we organize and deliver healthcare in America. Few healthcare organizations can escape, and most recognize they must lead, or at least join, the eminent shift toward population health, payment for value and medical home expectations.
Healthcare organizations are being called upon to define the populations they serve, identify individuals with care management needs, engage those individuals with appropriate intervention strategies and activate patients – the great underutilized resource in healthcare.
The signature goal is reducing the source of unsustainable costs – unnecessary ER visits and hospital stays. The signature path is shifting from a historically well-developed sick care system toward one that focuses more upon prevention, care management and health.
Practically, these shifts do not come easily for most healthcare organizations. It requires a change from the way healthcare has long been done. Recent reports authenticate that payment of volume still represented 89% of provider payments in the latest reported year past. And, a majority of patient flow represents individuals presenting themselves to healthcare organizations at the point of exacerbation or illness.
Despite the dominance of larger health systems fueled by the enterprise of acute in-patient stays, the Patient Centered Medical Home (PCMH) has been defined and chosen by many leading strategists as a path for operationalizing the shift of healthcare away from unnecessary higher cost to better health and better healthcare.
The promise of the PCMH revolves around transforming primary care practices as epicenters for most healthcare encounters. Ideally, the PCMH will practice effective population health strategies by providing evidence based prevention routinely, managing higher risk patients in their panels actively, and achieving improved clinical outcomes for those with chronic conditions proficiently. Plus, they must deal with the too often ignored behavioral health issues affecting large numbers of the population, efficiently.
Achieving the lofty promise of the Patient Centered Medical Home is a Herculean task. Primary care, along with select specialty practices, is being expected to shoulder the burden of systemic healthcare change by providing the foundation of coordinated care. This will involve accepting new roles in assessing the health status of their populations, stratifying for high risk members, pro-actively coordinating and managing care, leveraging technology, elevating preventative services, discerning appropriate referrals, utilizing community resources, achieving clinical outcomes and mitigating/reducing cost.
At the core of this “larger than life” role being written for the PCMH is an expectation that they will actually make healthcare truly patient centered. Hence, in addition to creating a robust healthcare enterprise, it is anticipated that they will lead a seismic shift for centering that enterprise around the patient.
The Patient Centered Primary Care Collaborative recently released their annual report highlighting the significant impact that PCMH has had on improving quality and reducing costs of primary care, The Patient-Centered Medical Home’s Impact on Cost and Quality: Annual Review of Evidence 2013-14. It stated, “The evaluations of the PCMH described in the report underscore the growing evidence base that ties the medical home model of care to reductions in health care costs and improvements in quality. However, in order for the PCMH to be sustainable, we need greater investment in primary care and less reliance on the fee-for-service payment system.”
Guided by physician leaders and supported through an effective team concept, a vital PCMH demonstrates capacity for transformation in healthcare.
However, of all the improvements in primary care, what is it that makes it feel truly a “home” to patients?
First, the personal relationship primary care physicians seek and value with patients is cornerstone of potential success. These physicians, along with their PCMH support team, often recognize that the patient is the great underutilized resource and effectively prompt patients to tap their own inherent potential.
Second, support for self-care skills are pivotal. As an example, if 95% of diabetes management is self-care, building patient competence and confidence in self-management is a practical strategy for leveraging healthcare knowledge rather than simply giving more time.
Third, with 98% of healthcare occurring outside the provider setting, PCMHs recognize the value of reaching into this large arena for impact. They acknowledge the principal role that health behaviors and patient understanding play in health outcomes and the health future of their patients. If 69% of healthcare costs are influenced by health behaviors, inspiring improved patient behavior and accountability is a sustainable path to pursue.
Fourth, emerging research underscores the high correlation between positive patient experience and improved health outcomes. While many factors influence experience, patients value a collaborative relationship rather than simply teaching, telling and directing. The idea is building a safe, supportive environment for patients growing accountability for their own health future.
A lot is being expected of the PCMH to transform healthcare. Many are learning how to fashion effective processes for a great healthcare house. The opportunity is to build upon the cornerstones of best PCMH practice and deliver a true Patient Centered Medical Home.
The Clinical Health Coach Training was designed, tested and refined in a patient centered clinic environment to support the best case transformation to a vital Patient Centered Medical Home. It may support your journey in that same quest. For more information, please visit www.clinicalhealthcoach.com