As the debate over health care reform continues, primary care medicine remains one of the key factors that would make health care more affordable. One solution, which could get funding in a federal reform bill, is the delivery model called Patient-Centered Medical Homes. PCMH connects patients with personalized healthcare teams in their communities, which in turn provide more focused, efficient and less costly medical services.
The Lake Erie College of Osteopathic Medicine and the Erie County Medical Society hosted three nationally recognized experts to speak with local physicians on Thursday, Sept. 3, at LECOM. Physicians and physician extenders attendeded the program.
Stanley Kozakowski, M.D., is the Director of the Hunterdon Family Practice Residency Program in Flemington, N.J., as well as the President of the Association of Family Medicine Residency Directors. He serves on a number of national committees that are investigating ways to implement the Patient-Centered Medical Home in practice and education.
Nancy Nielsen, M.D., Ph.D., is an internist from Buffalo, N.Y., and is the Immediate Past President of the American Medical Association. She has held and continues to hold numerous positions including the National Patient Safety Foundation Board of Directors and the Task Force on Quality and Patient Safety. She is a strong proponent of the need for affordable health insurance for all Americans. Dr. Nielsen will address healthcare reform and the AMA’s approach to the PCMH.
Carlo DiMarco, D.O., Immediate Past President of the American Osteopathic Association led the discussion during this program.
These health care leaders conducted a conversation about the PCMH - what it is, why it is important, and how to move toward its implementation as well as address healthcare reform and the future of medicine. According to Dr. Kozakowski, PCMY is about building the patient and physician relationship and making it work within the health care system for better patient care outcomes.
"Health care must be patient-centered, physician directed," state Dr. Kozakowski. PCMH facilitates this relationship with better record keeping and coordination of patient care, expanded access, a team approach, along with qulaity and safety.
The PCMH concept has become a very popular on Capital Hill, in business board rooms, and in medical conferences around the country as the debate over health care reform continues.
Dr. Nielsen described the process now going on in Congress. She pointed out that the current administration is not the first to change the way we deliver medical care. Reform plans date back to Franklin Roosevelt and the New Deal. Presidents Harry Truman, John Kennedy, Richard Nixon, and Bill Clinton all tried unsuccessfully to pass health care reform.
"This really the time to make this happen in a way that meets the needs of the patients," said Dr. Nielsen. "But, we need a way that allows physicians to deal with what the patient needs without bureaucrats and insurance managers."
Despite all of the discussion, there remains much confusion as to what this means and how does it differ from other health care reform models that have come and gone in the past.
The concept of the medical home has evolved from its first description in 1967 by the American Academy of Pediatrics as a place of usual care of children with complex chronic illness to most recently a joint statement of principles by the American Osteopathic Association, the American Academy of Family Physicians, the American College of Physicians, and the American Academy of Pediatrics.
The important difference between previous health reform movements and the PCMH is what appears to be a subtle but truly profound philosophical shift as well as definite changes in the delivery of care. It involves providing continuous care for the patient in front of the physician as well as care for the well-being of a population of people entrusted to the care of the healthcare team.
Paul Grundy, MD President of the Patient Centered Primary Care Collaborative recently described the principles of the PCMH as follows:
Personal Relationship: Each patient has an ongoing relationship with a personal physician trained to provide first contact, continuous and comprehensive care.
Expanded Access: Enhanced access to care is available through systems such as open scheduling, expanded hours, and new options for communication between patients, physicians, and practice staff.
Team Approach: The personal physician leads a team of individuals at the practice level who collectively take responsibility for the ongoing patient care.
Comprehensive: The personal physician is responsible for providing for all the patient’s health care needs at all stages of life or taking responsibility for appropriately arranging care with other qualified professionals
Coordination: Care is coordinated and integrated across all domains of the health care system, facilitated by registries, information technology, health information exchange and other means to assure that patient get the indicated care when and where they want it.
Quality and Safety: Quality and Safety are hallmarks of the medical home. This includes using electronic medical records and technology to provide decision-support for evidence-based treatments and patient and physician involvement in continuous quality improvement.
Added Value: Payment that appropriately recognizes the added value provided to patients who have a Patient-Centered Medical Home.