It is important to note a health care delivery is a process where continuous improvements in quality and patient-centeredness can be made. The Patient-Centered Medical Home or PCMH is a framework with the purpose of delivering healthcare services in a team-based manner to enhance comprehensiveness and continuity of care. The PCMH model can be considered an innovative, transformative, and novel approach to healthcare, which requires overcoming major barriers to physician competence as well as coordination of efforts.
Challenges and Opportunities
In order to properly and comprehensively discuss the merits of the PCMH model, it is critical to define it first. The PCMH is a patient-centered and team-based approach to health management, which seeks to increase the quality of care as well as reduce costs through greater efficiency (Wang, 2009). Physicians are central players in the given framework since they serve as connecting dots between different team members and patients. It was created as a response to the dysfunctional healthcare system of the United States, which is primarily based on a fee-for-service format.
The key opportunity of the PCMH model is that healthcare services will no longer be delivered separately and sporadically, but instead, they will be provided in the form of a package comprehensively addressing the needs of each patient. It can create an environment where a patient does not go from one doctor to another doctor receiving pointed healthcare services. If properly established, the PCMH has the potential to perfect its coordination protocols to make healthcare highly efficient, reducing costs for the patient as well as increasing the quality of care (Wang, 2009). The quality is improved because each disease is managed and addressed in a multifaceted and interdisciplinary manner leaving no room for errors.
However, there are challenges associated with the PCMH model, which mainly stem from how massively different it is compared to the existing systems. The biggest issue is the need for a complete overhaul and redesign of work processes when it comes to delivering high-quality PCMH services (Wang, 2009). In addition, “the industry must ensure that the rank-and-file, particularly small and midsized physician groups, understand the new approach” (Wang, 2009, p. 352).
It entails a new method of training, education, as well as healthcare system development. Evidence suggests that “the industry must give physician practices the necessary assurances about their financial security and secure a sufficient commitment from other stakeholders to ensure that PCMH will be more than just another reform fad” (Wang, 2009, p. 352). In other words, not all physicians feel confident in engaging in PCMH without any valid evidence, but it requires them to do so in order to create solid examples for its merits. Therefore, considerations must be made not only with respect to patients but physicians as well.
Implications of the PCMH Primary Care Model: Success
Although the PCMH primary care model had significant positive impacts on the healthcare industry in terms of disease prevention, there was and still is serious resistance within the field. It is reported that even partial PCMH implementation “achieved a 48 per cent reduction in re-hospitalization, 12 per cent reduction in emergency room visits, and 20 per cent reduction in hospital admissions” (Wang, 2009, p. 347).
Thus, it is evident that it works outstandingly at preventing disease complications and exacerbations. However, “there is universal concern regarding how physician practices can make the transformation from fee-for-service care to comprehensive care” (Wang, 2009, p. 347). In other words, the healthcare industry itself questions the practicality of such a model in the long run. Overall, one can see that the PCMH framework was successful at demonstrating that it can excel at preventing disease complications and hospitalizations. The reason is that even a mixed or partial integration of the PCMH provided positive outcomes for the patients.
Long-Term Implications of the PCMH Model
Nevertheless, it is important to make the system more practical and sustainable, which are the key long-term implications of the shift. It is reported that “physician practices have to invest anywhere between US$20,000 to US$80,000 per physician on electronic health records (EHR) software acquisition, installation and personnel training” (Wang, 2009, p. 347). Before investing large sums of money and resources into the model, there needs to be more evidence of how sound its financials are compared to the existing healthcare system. For example, “some practices may have to hire additional nurses to handle care coordination tasks. For small practices, this investment is a heavy financial burden” (Wang, 2009, p. 347). It is stated that the PCMH provides “better results in healthcare regarding access, quality of care, and cost” (Wang, 2009, p. 346). Thus, the success of the disease management industry, as well as empirical evidence, demonstrate that all three metrics can be improved.
Conclusion
In conclusion, as soon as the model is established on a larger scale instead of pilot programs, the costs are likely to decrease compared to the fee-for-service framework. For the quality of care metric, it is evident that the key emphasis of the PCMH on prevention makes it more appealing since it delivers better patient outcomes. Easy communication with doctors and their effort coordination enhances both the perceived quality of delivery as well as access.
Reference
Wang, H. (2009). Impact of the patient-centered medical home on stakeholders in the care management industry. Journal of Management & Marketing in Healthcare, 2(4), 343-354. Web.