Wednesday, October 21, 2015

What are medical homes and are they useful? By Ira Riklis

 Ira Riklis gives insight to the importance of medical homes and what they stand for. Also he includes a list of characteristics that were given by the AAP.

A Medical home also known as the patient-centered medical home (PCMH), is a team-based health care delivery model led by a health care provider that is intended to provide comprehensive and continuous medical care to patients with the goal of obtaining maximized health outcomes. The medical home concept first introduced itself in 1967 by the Academy of Pediatrics (AAP). In the original version, the AAP defined the medical home as the center of a child's medical records. At the time the care of children with special medical needs was the main focus and concept of the home. Over time, however, the meaning of a medical home has changed to reflect the ever changing needs and perspectives of health care.

Modern Medical Home

The modern medical home has expanded on its original foundation, becoming not only a home base
for a child's medical care, but also non-medical care. The modern medical home's focus has also shifted to include not just children with special medical needs, but also to adults. Today's home is a partnership between family, patient, and primary provider. Cooperation from specialist and the community is also a major feat. The patient and family is the focal point of this model, and the medical home is built around this center.

In 2002, the AAP stated an explanation of what the home's characteristics were. These characteristics or guidelines stress that care under the medical home must be accessible, family-centered, continuous, comprehensive, coordinated, compassionate, and culturally effective. In 2007, the AAP joined with the American Academy of Family Physicians (AAFP), the American College of Physicians (ACP), and the American Osteopathic Association (AOA) to form the Joint Principles of the Patient Centered Medical Home. Under the collaborative effort, the characteristics of the medical home have been defined within seven major principles.

1. Personal Physician:

  • Each patient has an ongoing relationship with a personal physician who has been trained to provide first contact, continuous and comprehensive care.

2. Whole person orientation:

  • The personal physician is responsible for providing for all the patient's needs or taking responsibility for arranging care with other qualified professionals. This can include care for all stages of life from acute care to chronic care, to preventive services and even the end of life care.

3. Care is coordinated and integrated:

  • Across all spectrum of the complex health care system and patients community, care is facilitated by registries, information technology, health information exchange, and other means to assure that the patient gets the exact care when and where they need and want it in an appropriate manner.

4. Quality and Safety:

  • Evidence-based medicine and clinical decision-support tools guide decision making.
  • Physicians accept accountability for continuous quality improvement through voluntary involvement in performance measures and improvement.
  • Patients participate in giving feedback to help improve quality of the medical home and to reassure that all of their needs are being met.
  • Information technology is utilized appropriately to support optimal patient care, performance measurement, patient education, and enhanced communication.
  • Practices go through a voluntary recognition process by a non-governmental representative to demonstrate that they have the ability to provide patient centered services with the specific medical home model.
  • Patients and families participate in improvement activities at the practice level

5. Enhanced care access:

  • Available through systems that allow open scheduling, extended or extra hours, and new
    options for communication between patients, their person physician or specialists, and practice staff.

7. Payment:

Appropriately recognizing the value provided to patients who have a patient-centered medical home, the payment structure should be based on the following framework:
  • A reflection of the physician and the non-physician staff work that falls outside of the face-to-face visit.
  • It should pay for services in coordination of care within a given practice and between consultants, ancillary providers, and community resources.
  • Support for adoption and use of health information technology for improvement.
  • Support for provision of enhanced communication access such as secure email and over the phone consultation.
  • Recognizes the value of physician work associated with remote monitoring of clinical data using technology.
  • It should allow for separate fee-for-service payments for face-to-face visits.
  • It should recognize differences in the patient population being treated within the practice.
  • Allow physicians to share in savings from reduced hospitalizations associated with physician-guided care management.
  • Allow for additional payments for achieving continuous quality improvements.
A medical home is an important mechanism for unifying the many segments of health care. Not only is it important for children with special needs but also adults. Medical homes are crucial for many people and without them a great amount of people could and would go untreated.

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