The Patient-Centered Medical Home

A recent article (May 20, 2009) by Dr. Diane Rittenhouse and Dr. Stephen Shortell published in the Journal of the American Medical Association was an excellent commentary on a new model of healthcare delivery called the patient-centered medical home. According to these authors, "the fundamental challenge in the United States is to expand access to all U.S. residents, while rapidly reengineering the delivery system to provide consistently high-quality care at lower overall cost. Current reform discussions recognize that success will require a shift in emphasis from fragmentation to coordination and from highly specialized care to primary care and prevention." This is where the the patient centered medical home model comes in to being.
The patient-centered medical home is grounded on four major supporting structures:
1. Primary Care
2. Patient-centered Care
3. New-model Practice
4. Payment Reform.
The importance of primary care is based on years of research demonstrating the role of primary care in producing more positive outcomes at lower costs. Primary care is comprehensive, first-contact, longitudinal and coordinated medical and preventive care delivered by a team of providers spearheaded by the physician.
Patient-centeredness is the tailoring of medical care to meet the needs and preferences of patients. Active participation by the healthcare consumer leads to shared decision-making regarding treatment strategies. Traditional and nontraditional communication (i.e. Internet or virtual office visits) is critical to promoting patient-centeredness.
New-model practice builds on innovations in healthcare delivery: continuous quality improvement, patient safety, transparency and accountability. Evidence-based medicine, population-based healthcare systems, performance measurement and improvement, point-of-care decision support and information technology (i.e., the electronic medical record) are additional areas of concentration promoting the new-model practice.
Payment reform requires, in addition to traditional fee-for-service, additional payment mechanisms to reimburse clinicians for jobs well done. Pay-for-performance and care management are two additional structures being considered to help primary care practitioners in establishing and delivering on the patient-centered medical home.
In reality, what this all means is that when patients have easy access to high quality care that is provided at a lower cost, everybody wins. The U.S. healthcare delivery system is on the brink of a major collapse. It is a distinct possibility that if we continue as we are, our nation will have a national healthcare delivery system much like our neighbors in Canada. This would certainly save money. But would it promote the kind of healthcare that U.S. healthcare consumers have become accustomed to?
According to Rittenhouse and Shortell, marketplace and political realities will necessitate action on healthcare delivery system reform in the U.S. the widely endorsed patient-centered medical home has the potential to increase access and quality and to decrease the rate of growth in costs over time. As healthcare reform gains momentum, this model of healthcare delivery is sure to be tested. The results of this experiment will undoubtedly shape the future of healthcare delivery in our nation for decades to come.
Dr. Dale