Patient Centered Medical Homes (PCMH) are often confused as being actual “homes” for patients to be admitted in and given medical treatment and care. PCMH is actually a health care model based on which health care is provided to patients, under the supervision of physicians. The PCMH model of health care provides patients with continuous, comprehensive medical care, in order to increase the chances of achieving the goal of benefitting the patient with as much attention and medical care in order to maximize his/her health outcomes.
Over the years the PCMH model of health care has become widely adopted and preferred. This is because of the philosophy and approach that the model adopts in organizing and delivering the health care initiatives. The PCMH model is based upon delivering medical care and attention to patients with team-based health and medical experts that are focused strongly on the quality and the safety of the type of health care being provided to the patient in question, in accordance to the patient’s medical history and ailments. This model of health care caters to all sorts in the population from children to senior citizens. The PCMH team model encourages the team of physicians and medical experts to show compassion, be accessible, and build a relationship with the patient based on transparency, healthy communication and of course trust. Each PCMH uses up-to-date, advanced modern technology in the health care that aids in the success of the venture. Payments for the medical care have been made easier with new innovative methods that do not put much burden on the patient of health care bills. PCMH is widely accepted because of the way it not only treats people from their diseases but also cares for their future, family and finances.
PCMH have certain features that set them from apart from other regular hospitals. These are the standard features of all PCMH, and are mentioned in the Accreditation Association for Ambulatory Health Care’s Handbook for the purpose of being accredited as a certified PCMH. Being a medical home, its aim is to deliver all sorts of primary care, with all sorts of physicians and medical practitioners located in the same premises so that the patient can find whichever physician he wants treatment from. Another aspect of PCMH is that they are patient-focused. The physicians in a PCMH ensure that the decisions and wishes of the patients and their families are respected with regarding to the treatment procedures and approach taken. They enable the patients to not only participate in their own care but also educate them in the ailments and cures available in order to them to make well-informed, well-thought out decisions. These PCMH are comprehensive when it comes to the performance of their job, which is to tend to the patient’s health and other medical needs, and wholly and solely take it in their responsibility. The health needs not only involve the physical needs, but also the mental wellness of the patient as well as prevention of any disease and emergency chronic care. The method of providing the health care is well coordinated. With systems in place at hospitals, specialty care units, home health care etc. The major feature is that it is accessible to patients at all times for any emergency situations that might arise. The PCMH make medical health care service available via “24/7” service centers, after-hours care units, and telephonic access to medical advice. Equipped with the best medical technology that the era has to offer, the quality of the care being provided to the patient is the best that can be done for the diseases at the time. The availability of such equipment allows it easier for the patient and their families to make informed decisions regarding the medical care that the patient requires.
The idea, the vision and the concept of PCMH has been present for quite some time now, but the implementation of this policy has been rather recent in the United States of America. The idea was considered to be equivalent to achieving a milestone in the medical and the social healthcare field in the United States. PCMH has been supported by many different business and companies that aim towards reforming the health care sector in the U.S. Many different projects have been launched by several public and private-based organizations since 2002. One of the most famous projects has been the ‘Patient-Centered Primary Care Collaborative’ that was launched in 2006 (Backer, 2009). The project has been started by several organizations, including IBM as well. Based on the immense support and the possible advantages, it was estimated in 2004 that the costs of health care would be reduced effectively by almost 5.6% annually if PCMH projects were started, which would result in the saving of over 67 billion dollars each year, and the quality of health care would also increase, thus resulting in an efficient, cost effective and highly socially beneficial health care in the U.S. (Spann & Team, 2004).
Although the time period since the PCMH projects have launched and become part of the U.S. health care system has been relatively short, the findings from them have been encouraging in health care terms and also economical and social terms in the country. It has been noted that patients that have been provided with health care in medical homes have been more prepared in managing their chronic diseases rather than those who do not go to medical homes. These patients become more aware of their diseases as medical homes also aids them in understanding their diseases and providing knowledge about them so that the patient becomes less reliant on curing medical care and focuses on preventive care. For example, the U.S. citizens who visit such medical homes and clinics have been noticed to be more likely to report about checking their blood pressure levels and in keeping the levels in control. Moreover, the medical homes have resulted in disparities amongst the general population of the country based on the ethnic grounds have reduced in the availability, accessibility and receipt of health care services. Primary beneficiaries of this advantage have been to the Afro – Americans and Hispanics in the country. Prior to the introduction of medical homes, these people could not access the expensive health care services as they were only accessible to white people in the country. Moreover, they did not acquire enough income so as to receive services from the private doctors and medical clinics. The medical homes also have benefitted the lower income group and the uninsured people in the country. PCMH has provided them a chance to be able to acquire high quality health care services in the country on low cost.
The advanced nurse practitioners (ANP) are those personnel who get involved with patient on a more focused basis as a personal provider who looks after the whole person rather than focusing on only one disease or medical problem. The ANP’s have been responsible in the medical homes to provide safe and high quality care to the patients as part of the overall health care providence. Commonly, ANPs have been noted to provide mostly primary health care. But in medical homes, the role of the ANP increase drastically as they are also responsible to provide the patient assistance not only on the health care level but also on the mental level to encourage the patients to be more preventive and precautionary about their health. These ANPs have the role to provide higher level of care to the patients so that they are encouraged to come to medical homes rather than opting for expensive private doctors who only focus on the primary disease, ignoring other issues most of the time. The health care reforms in the U.S. have revealed at least two unique roles of the practice of ANP’s in medical homes. These are providing high quality health care to patients and establishing unique involvement of ANP’s i.e. they can focus on contributing to the health care in medical homes to patients by focusing primarily in the diseases of chronic nature (De Geest, Moons, Callens, Gut, Lindpaintner, & Spirig, 2008).
The idea of medical homes has been established on the requirement of providing all the people equal and high health care facilities. Another reason was the inefficiency and disparities based on income level and ethnicity in the country. These factors laid down the basis for the development of such Patient Centered Medical Homes in USA. The issues can be more elaborated to explain their definitions. The issue of high cost by medical practitioners, especially the expensive private health care services raised the concerns about the lack of accessibility for high cost health care for the lower income group of the nation. The policy or legislation would help the poor people of the country to be provided with advanced high quality health care by PCMH.
Health care is an expensive ordeal mostly for the lower income groups in the United States. The under privileged and the poor people are usually unable to seek health care from private specialists and basically have to rely on the public hospitals and clinics. Here the focus of the medical staff remains on the issue or disease that has brought the patient to the hospital. However, the notion of medical homes ensures that people receive health care by expert practitioners who are equivalently good as private doctors and their focus does not only remain on the disease or illness but they focus on the entire human body and follow up with the patients with checkups on regular basis. This allows the people to attain the facility of quality health care whilst paying small amounts of money for treatment s as compared to those charged by the private practitioners. Thus, the basic problem that is intended to be solved by the legislations and policies regarding medical homes is the inability or insufficient accessibility to quality health care that is affordable by the citizens of the United States of America.
The concept of Patient Centered Medical Homes, as mentioned earlier, has been slow to become a major part of the health sector in the United States. But gradually this idea has grown into a solid reality throughout the country and by the end of April 2013, over 40 states have successfully adopted the policies and the programs to develop and further grow the medical homes (NASHP, 2013). The federal government of the United States and the states themselves have presented and passed a number of legislations and policies in recent years relating to the promotion of medical homes throughout the country. One of the very first legislations signed on the federal level was the bull passed by the U.S. Congress in 2006, titled the ‘Tax Relief and Health care Act of 2006’ (109-432, 2006). This bill mentioned a few rules and laws to setup the basic structures of the medical homes and also impacted upon the techniques and methods used to apply these legislations. This bill mentioned that the development of medical homes was to be done based on the careful planning and coordination amongst the parties involved in the medical homes sector of health care. It further mentioned that the medical homes would be required to use the health information technology to grow as a more advanced and efficient system of health care in the country in the years to come. This technology would allow the physicians and nurses to provide the patients with high quality medical care whilst educating them about the techniques to self work toward treating the diseases. This legislation also asked for the introduction of the individual health assessments and management’s planes in relation to the medical homes. The legislation also discussed about the prospective fee for care management to be charged by the medical homes and to be paid by the general public. The passing of this bill had several impacts on the development of the medical homes in the country. Demonstrative medical homes were established to support the people throughout the United States. But these demonstrations were for the Medicare beneficiaries who were on the list that established the level of the people who were regarded as ‘high need’. These demonstrations were run set up to run for 3 years and in around 8 states. A mixed set of locations were chosen to demonstrate the differential impacts of the medical homes in different localities and also included a mixture of types of practices done by the existing practitioners and nurses. The legislation also required for the care management systems to provide the prospective fee to be charged for the care management in the medical homes.
Further down the months, following in the footsteps of the U.S. Congress, the state government of the Louisiana state presented a local legislation that aided with the establishment of medical systems within the state. In 2007, the Louisiana Act 243 explained the medical homes in a more refined and clear manner and stated its core features and functions. Medical homes were described as system of cares that incorporated the patient centered care and were PCP directed. The legislation also discussed about the preventatives techniques and the primary care so as to ensure that the patients could be more efficient and take keen part in their own health care. The legislation also mentioned about the need to establish an integrated system of specialists, PCPs (Primary Care Providers) and the hospitals so as to strengthen the laid down basis of the medical homes development. The immediate impact of this regulation was that the state health department was made responsible for the research and the establishment of the medical home care system in the state that would aid the population that was low income and uninsured, whilst being Medicaid members. Moreover, this legislation also required the department of health of the state to develop a more advanced methodology of making Medicaid reimbursements for those providers who were participating.
A different legislation, the Vermont Act that passed in May, 2007, outlined the definition and understandings of the medical homes based on the legislation or policy that was established by the U.S. Congress in the previous year. Additionally, this legislation explained that the patients were required to take care of themselves and get educated regarding their illnesses to ensure that preventative and/or precautionary measures were taken to avoid the need to visit a medical home, thus explaining the role of the patient as well in the proposed and developing health care system regarding the medical homes. The impact of this legislation was quite important as it required funding a demonstrative project of medical homes for the enrollees of the Medicaid, State Employee Health Plans and the Catamount Health. This demonstrative medical home expanded the range in terms of number of people to be treated as a higher number of people were the direct beneficiaries of the demonstrative project to be established. In July 2007, the state of Washington passed a bill that defined within it the medical home as a site of care as “a site of care that provides comprehensive preventive and coordinated care centered on the patient’s needs and assures high-quality, accessible, and efficient care” (Thiessen, 2007). The impact of this legislation was that it required for the state health department to create a 5-year plan that detailed about the provision of a medical home to all the people enrolled on the state health plan. Moreover, this legislation required the state health department to design and establish patient centered medical homes for the old aged people, the disabled people and those who were blind. The special point about this legislation was that it emphasized on the reform of payments and setting the goal to allow the existing primary care providers to continue with their practice and focus in the better coordination of the health care relating to chronic diseases.
Evidently, the legislations on state levels have been different and have varied with the level of reforms and targets set. These legislations equivalently have had their pros and cons. One of the major pros of all the legislations has been that they have established the demonstrative medical homes for certain time periods. This would allow them to understand the nature of the medical homes and would be taken to determine the success of the health care system based on the medical homes as compared to the already existing health care systems. However, one of the major disadvantages of most of these legislations is that they fail to recognize the need to establish separate medical homes for the old and the disabled. On a personal note, the problem that has led to the reform towards medical homes-based health care structure being developed in the country truly has been such a problem that needed to be addressed effectively by the United States government. The problem was gradually increased the gap between the public health care and the private health care services that were more superior based on the treatments and expertise available. The legislations regarding the medical homes have served to dismantle such differentiation in the eyes of the public and make the poor and low income level members of the society to be able to afford high quality health care at affordable rates. Although, the concept of medical homes has been quite new to the people of the United States of America, it seemingly would prove to be an effective solution in the future for a better and efficient public health care system.
109-432, P.L. (2006, December 20). TAX RELIEF AND HEALTH CARE ACT OF 2006. Public Law 109-432 (109th Congress) .
Backer, L.A. (2009). Building the Case for the Patient-Centered Medical Home. Family Practice Management 16 (1), 14-18.
De Geest, S., Moons, P., Callens, B., Gut, C., Lindpaintner, L., & Spirig, R. (2008). Introducing advanced practice nurses/nurse practitioners in health care systems: a framework for reflection and analysis. Swiss Medical Weekly (138), 621-628.
NASHP. (2013, April). Medical Home & Patient-Centered Care. Retrieved from The National Academy for State Health Policy: http://www.nashp.org/med-home-map
Spann, S.J., & Team, T.F. (2004, December). Task Force Report 6. Report on Financing the New Model of Family Medicine. Annals of Family Medicine. 2 Suppl 3 (Suppl 3): S1 — 21.
Thiessen, K.K. (2007, April 22). Chapter 44.20 RCW Regular Session Sixtieth Legislature. Session Laws of the State of Washington . Olympia by the Statute Law Committee .
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