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So It’s Not a Home Then?

The name is a bit deceiving. Rather than being some sort of facility run by a hospital or health care provider, the Patient-Centered Medical Home (PCMH) is a philosophy of health care delivery. Its primary goal is to provide people with  quality, organized, and comprehensive health care by crafting a network composed of an individual’s physicians and community.

The medical home model was initially proposed in 1967 by The American Academy of Pediatrics to refer to a central location for a child’s medical record. In 2002, they expanded the concept of the medical home to include operational characteristics. The medical home became a model for “continuous, comprehensive, family-centered, coordinated, compassionate, and culturally effective care.” In the following years, other groups, such as The American Academy of Family Physicians, developed their own models for improving patient care. Finally, in 2007, The American Academy of Family Physicians, the American Academy of Pediatrics, the American College of Physicians, and the American Osteopathic Association jointly established a set of principles to describe the universal characteristics of medical homes. They created a system focused on patient comfort and health, dedicated to streamlining health care and focusing on the quality of the care provided.

5 Core Values

Since then, the medical home has garnered recognition as an effective and acceptable model for patient care, and the principles behind it have been refined to reflect the central values of the philosophy. As outlined by the Agency for Healthcare Research and Quality (AHRQ), the medical home has five core qualities:

  1. Patient-Centered: All decisions respects patient’s wants, needs, and preferences. Patients are also provided with the education and the support to be able to participate in their care.
  2. Comprehensive: A team of health care providers is entirely accountable for the patient’s physical and mental health care.
  3. Coordinated: Care is organized and encompasses all elements of the health care system, such as hospitals, specialty care, and community supports.
  4. Accessible: The medical home provides accessible services by shortening waiting times, offering around-the-clock electronic access to a member of the team, and creating alternative communication methods.
  5. Committed to Quality and Safety: Evidence-based medicine, performance measurement, and responding to patients’ experiences ensures that patients and their families are engaged and that the medical home is constantly working towards improving its practice.

The medical home holds professionals and the health care system to a higher standard. Because the primary motive of the medical home is to create comprehensive and quality care for patients, medical professionals are required to have extensive knowledge of the health care system, the management of information, and the relationship between payment models and delivery methods. It is not enough to simply understand medical practice; professionals must also understand the intricacies of economics and management behind health care, as well as those of the community, because it is this understanding that acts as a foundation for the establishment and application of the PCMH.

The Medical Neighborhood

The PCMH exists to manage the Medical Neighborhood, which is defined by the Patient-Centered Primary Care Collaborative as, “a clinical community partnership that includes the medical and social supports necessary to enhance health.” The medical home serves to coordinate the various “neighbors,” in order to improve the flow of information between physicians and their patients, as well as between multiple health care professionals. These “neighbors,” could be specialists, faith-based organizations, schools, long-term care, hospitals, or groups such as the YMCA and Meals on Wheels. The medical home unifies the neighborhood and encourages collaboration amongst the neighbors so as to provide holistic health care to patients that promotes healthy environments and behaviors.

Better Experience and Better Health

The concept of a Patient Centered Medical Home may sound rather idyllic, and one may question what exactly it accomplishes. Across more than 300 studies, better primary care has been associated with increased quality and decreased growth of health care costs. A PCMH, centered upon the idea of improved primary care through collaborative health services, is able to increase efficiency within the system and the quality of patient experiences. Enhancing the role of the community improves access to services for patients, which leads to better health outcomes. There are added benefits to the community by lowering the prevalence of disease and disability, decreasing lost productivity and transitively health costs, and increasing coordination between clinical and public health outcomes. Just as the medical home operates within a network rather than linearly, the possible benefits are interwoven amongst the patients, the health care system, and the community. The resources and efforts used to sustain the medical home are returned in better patient care–including the increased likelihood of preventative care–and a healthier community.

The medical home shifts the thinking behind the health care system: rather than working independently from each other, the different branches of health care are unified behind a shared objective. Patient experience and their overall health, both at the time of care and in the future, are of the highest importance. With this goal in mind, the medical home creates a network of resources that work together to best accomplish it, simultaneously benefiting health care practices and their communities.

 

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