In recent years, the patient-centered medical home (PCMH)—often referred to in its abbreviated form, the “medical home”—care delivery model has become one of the hottest topics in healthcare. Based on a holistic, patient-centric approach, the PCMH represents a methodology aimed at fostering increased collaboration among healthcare stakeholders. As such, the PCMH is widely believed to offer perhaps the best hope to transform and improve the system as a whole.

For example, Geisinger Health System reduced hospital readmissions by 18% through its medical home program and by 44% with its ProvenCare one-price elective cardiac surgery medical home program.¹ Paul Grundy, MD, MPH, Global Director of Healthcare Transforma tion for IBM and Chairman of the Patient-Centered Primary Care Collaborative, recently stated in his keynote presentation of the Medical Home Summit in Philadelphia that his review of evidence from ongoing PCMH pilots has resulted in a 9.6% overall reduction in costs.²

To a certain degree, the PCMH is a reversal of the longstanding episode-based methodology that has been prevalent in healthcare for many years. Unlike the episodic-based care, the PCMH encourages patients and their providers to work closely together to ensure that care is more comprehensive, coordinated, and consistent. In essence, the medical home necessitates an ongoing, full-spectrum approach to patient care that requires the primary healthcare provider and the patients themselves to maintain complete awareness of the patients and their specific healthcare needs and experiences. This approach should result in more streamlined and appropriate care, reduced waste, lower costs and, most important, better outcomes.

Although the PCMH model had already been building momentum on its own, interest in this concept skyrocketed after it received a significant endorsement in the Patient Protection and Affordable Care Act (ACA) of 2010. That legislation strongly encourages the proliferation of medical homes and accountable care organizations (ACOs) as innovative means of delivering and reimbursing for better coordinated and cost-effective care.

The Patient-Centered Primary Care Collaborative (PCPCC.net) is an organization with the goals of facilitating improvements in patient–physician relations, and creating a more effective and efficient model of healthcare delivery. They have created a stakeholder group charged with showing that the PCMH provides the foundation for successful implementation of the ACO delivery model. Moving patients through the ACO will require a strong element of care coordination, so we look forward to seeing the results of this group.

ACOs and the Patient-Centered Medical Home
An ACO is a business and a medical entity that accepts responsibility for the cost and the quality of care provided to a given population of patients and generates the data on their performance. This includes physician practices and may include hospitals, nursing homes, home health agencies, and other provider organizations.

The ACO model is called out specifically within the ACA as a preferred solution for bending the healthcare cost curve, while improving patient outcomes. There is funding within the bill to implement ACOs for Medicare and Medicaid,³ and the criteria have already been determined for ACOs to become involved with both programs. Because the PCMH will provide the care coordination that is required to make the ACO model work, most ACOs will likely take root in areas that have a sufficient number of medical homes.

The Benefits to Patients and Providers
In addition to the system-wide improvements it is expected to foster, the PCMH can also offer distinct sets of benefits for healthcare’s primary stakeholders—patients, providers, and health plans. In a medical home structure, the patient is aligned with a care coordinator (normally a registered nurse, physician assistant, or social worker) at the provider practice level whose primary function is to manage the patient’s health across the care spectrum.

The care coordinator interfaces on the patient’s behalf with the health plan, specialists, pharmacists, labs, and other stakeholders to formulate a more efficient and holistic approach to treatment. This generally results in a more informed and engaged patient—one who, through the care coordinator, has a more simplified access to care, better understands his or her own needs, and is more likely to comply with treatment recommendations and suggested preventive measures.