Illness can be overwhelming, and the logistics of managing medical care make it even more so. For patients and their families, scheduling tests, tracking appointments and following up on next steps is often a source of significant stress.
The Patient-Centered Medical Home (PCMH), an innovative patient-provider model that centralizes care through primary doctors' offices, aims to ease that burden. The PCMH is designed to streamline the patient experience by making primary care doctors the medical home base through which all other patient care is coordinated and monitored. New England Quality Care Alliance (NEQCA) was an early adopter and leader of the PCMH, much to the benefit of our patients. As of November 2015, 33% of the practices recognized as a PCMH in Massachusetts were from NEQCA.
"Your primary care doctor should know about everything that happens to you," explains Candace Perry, a medical home and practice quality senior manager for New England Quality Care Alliance's Medical Home Program. "If a patient needs to see a specialist, they should go to their primary care physician to coordinate that care. They're the general contractor for your health."
NEQCA experts have worked diligently to find the best methods for implementing a PCMH and and sustaining it success. These three elements are the most important:
- Crosswalk of Quality Measures: All providers are inundated with programs related to quality improvement. PCMH implementation streamlines quality and creates a “one stop shop” for NEQCA practices. Instead of thinking about what insurance is asking, PCMH workflows adopt a consistent model of care that focuses on the patient.
- Build an Expert Team: PCMH implementation is rewarding, but small practices do not have the resources to learn all of the nuances. NEQCA created a team of project managers and practice support. NEQCA team members are well versed with the PCMH standards of care and electronic medical record (EMR) usage (which is critical to a successful PCMH).
- Implement in Phases: Implement the concepts of PCMH in small bites. Practices need time to learn the PCMH; therefore, grouping similar concepts together within 5 “mini” implementations lessens the strain..
Putting Patients First
For most of us, a primary care doctor's office serves as the entry point for our health care. As such, the PCMH initiates comprehensive care from a provider team, which is accountable for your every need — from prevention and wellness to acute and chronic care. And you don't have to bounce around from office to office. Instead, the PCMH ensures care is organized from one office across all elements of the broader health care system, including specialty care, hospitals, home health care, community services and long-term care supports.
Care is also accessible. PCMH practices aim to offer shorter waiting times, more-convenient in-person hours (so it's easier to make urgent appointments), 24/7 electronic and/or telephone access and alternative methods of communication (such as online portals and apps). Through the PCMH, patients can contact a doctor or easily access medical records and expect a quick response. NEQCA helps practices introduce the necessary technology and workflow.
"The PCMH puts the patient at the center of care. There's better support, communication and relationships, which results in better patient and provider experiences," says Perry. "If you call your physician after hours, they're not calling back hours later; they call within 15 or 30 minutes. Then the encounter is documented, so when you come in two months later, the doctor can reference that phone call and close the loop to make sure the problem was resolved."
Long-Term Benefits for Better Health
A Patient-Center Medical Home has other proven benefits, such as fewer inpatient hospital stays, stronger patient-provider relationships and reduced long-term health care costs, thanks to regular contact and better communication and follow-up. This model mimics those in other nations where effective systems prioritize primary care.
Consider this: Although the United States spent more than $2.9 trillion on health care in 2013, just 4 to 7 percent of that total was dedicated to primary care. Despite this, primary care visits in the United States account for over half of physician office visits each year. It makes sense that the PCMH — and NEQCA — put primary care at the forefront for patients.
"This is a true paradigm shift for patient care and quality, and NEQCA is leading the way," says Perry.