This post was written by our Guest Blogger Susan Maxsween who is our Healthcare Transformation Manager at RMS.

In addition to being well-branded in market research, RMS also has a dedicated healthcare team to assist you with your healthcare transformation needs.  Are you wondering how to become certified with the National Committee for Quality Assurance (NCQA) or just need some more information on Patient-Centered Medical Homes (PCMH)?  Well, you’ve come to the right place – the Research Bunker.

The concept of a Patient-Centered Medical Home is the national buzz and being touted as the new method of delivering health care.  More importantly, the PCMH approach has and will continue to impact the reimbursement paid to physicians under new payment reforms.  PCMH designated practices are receiving higher fees from the government and health insurance payers.

A model of care designed to put the needs of the patients first, the concept is receiving a great deal of attention as an alternative to traditional disease management approaches.  It provides for coordinated and integrated care across all elements of the healthcare system.  It is based in primary care, but impacts the complete array of health care delivery from primary care to specialty care to hospital care.

Essentially, the PCMH is the base from which health care services are coordinated to provide the most effective and efficient treatment for the patient.  This includes the use of health information technology, the coordination of specialty and inpatient care, the treatment of acute and chronic illnesses and more.  The medical home is founded on several components:

  • Enhanced self-management by patients of their condition;
  • An organized and sophisticated delivery system;
  • Evidenced-based support for clinical decisions;
  • Information systems; and
  • Links to community support groups.

“The vast majority of health care should be coordinated through a primary care physician,” said Robert Berenson, M.D., a senior health policy fellow with the Urban Institute. The primary care physician is responsible for the complete spectrum of health care services the patient is receiving.  Each patient has an ongoing relationship with a personal, primary care physician trained to be the first contact, coordinating comprehensive care on their behalf.  For chronic and/or intensive conditions, a team approach is utilized incorporating the patient, patient’s family, and personal physician into a formalized health care planning process.  “I think it’s time to recognize that a one-size-fits-all physician payment system may no longer work properly to support the increasing diversity of physician activity that has resulted from industry sub-specialization,” Berenson said.

PCMH Principles

  1. Treat the Whole Person – the core concept is to have a personal physician who partners with the patient to coordinate and facilitate all medical care.
  2. Patient Needs First – the model puts the needs and desires of the patient first, by creating an environment where patients have a relationship with a doctor who knows them, their medical history, and their family.
  3. Quality/Safety Emphasis – evidence based medicine, health information technology, and clinical decision support tools guide decision-making to support patient care, performance measurement, patient education, and enhance communication.
  4. Better Delivery Model – results prove that PCMH results in lower hospitalization rates, lower rates of death for heart disease, cancer, and stroke and reduced rates of medical errors – which has shown to improve quality, increase patient satisfaction, and cost efficiency.
  5. Better Payment Model – it reflects the value of physician care management work that falls outside of a face-to-face office visit.  It pays for services associated with coordination of care, supports adoption and use of health information technology.

In the increasingly fragmented world of health care where many medical specialties limit their practice to a particular organ, disease, age or sex, emphasis needs to be placed upon primary care physicians who are dedicated to treating the whole person across the full spectrum.  Primary care medicine’s cornerstone is an ongoing, personal patient-physician relationship focused on integrated care.

For more information on how to be NCQA certified, if you have any questions about quality assurance or if you are interested in NCQA accreditation, call Susan Maxsween here at RMS at 315-635-9802 or e-mail her at SusanM@RMSresults.com.

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