The patient-centered medical home (PCMH) is a new healthcare model that helps practitioners in the primary care to achieve quality patient care at a lower cost (Bair-Merritt et al., 2015). The cost of care rose over the last few years and healthcare facilities face a lot of challenges in trying to meet the needs of the patients. Further, many healthcare complications have come up thus mandating an improvement in clinical practices. The PCMH is an ideal model that is centered on the patient’s needs and it ensures that organizations design their primary care services in a way that meets the consumer expectations (Fifield et al., 2013). The joint principles of PCMH are physician-led practices, whole-person treatment, integrated and coordinated care; focus on quality and safety as well as improved access. Different organizations such as the American academy of pediatrics, the American osteopathic association, and American college of physicians among others were involved in the development of the PCMH and they ensure that the model is applied in the right manner (Strange et al., 2010). PCMH seeks to serve people of all ages, including children, teenagers, and adults. Organizations that adopt the PCMH see a great improvement in their practice, enhanced patient satisfaction, and profitability.
A practice must meet several requirements of the PCMH as well as fulfill the six standards that the model uses to measure the performance of different organizations. A practice must have a permanent location and at least a clinician to offer primary care services. The six standards include patient centered access, team based care, population health management, plan and manage care, track and coordinate care, and measure and improve performance (Strange et al., 2010). Each of these standards has elements that must be fulfilled by every practice that embraces the PCMH model. About 75% of a clinician’s patient must visit for first contact care, continuous care or comprehensive care for the practitioner to become a PCMH eligible. A successful practice achieves high scores in patient centered appointment access, the practice team, use of data for population management, care planning and self-care support, referral tracking, and follow-up and implement continuous quality improvement (Fifield et al., 2013). Compliance with the PCMH requirements means that one follows the set standards and the subsequent elements listed in each of the model’s standards.
Standard I: Patient Centered Access
The first standard as described by PCMH is patient centered access. The standard aims at ensuring that each practice has access to team-based care for urgent and normal routines. The first three elements ensure that the first standard is fulfilled by different practices to improve the quality of care and reduce the subsequent cost associated with primary care. The elements include patient centered appointment access, 24 hours access to clinical advice and electronic access. Element 1A (patient-centered appointment access ensures that a practice allows patients to see practitioners at any time by allowing appointments outside the regular time, giving alternative clinic encounters and encouraging same-day appointments. A practice has well written policies that help the patients to know the available services (Green et al., 2012).
The availability of these services ensures that patients have access to their physicians 24 hours a day thus fulfilling element 1B. Element 1C (Electronic Access) ensures that patients have access to their online database that contains personal information about primary care. Practitioners provide the patients with access codes after four business days have elapsed since the appointment. Further, at least more than 50% of the patients must download their information or give it to a third party for a practice to be compliant to this element. Through the online database, patients can make appointments, request referrals, and have a two-way communication with the physicians.
Standard II: Team Based Care
The second element ensures that a practice is culturally and linguistically sensitive as it offered team based care. The purpose of the element is to ensure that people are not locked out of proper primary care because their cultural practices are uncommon or due to language barriers (Bair-Merritt et al., 2015). The elements included in this standard are continuity, medical home responsibility, CLAS, and the practice team. A practice has to pass the requirement of each of these elements to become compliant of the second standard of PCMH (Green et al., 2012). Element 2A (continuity) ensures that patients are helped to choose a persona physician, monitors the number of patient visits that a team receives at a particular time, orients new patients to the practice and assists the patients and the family to develop a care plan to transition from pediatric care to adult care.
Element 2B (medical home responsibility) ensures that a practice has a set practice to inform patients of the medical home. Further, patients are provided with materials that contain vital information about care, such as instructions for obtaining care and clinical advice. To fulfill element C (CLAS), the team analyses the diversity of the patients under its care and provides printed material with the necessary cultural or language assistance. Bilingual services or interpretation services are offered to achieve success in primary care (Green et al., 2012). A practice team is set up to serve a group of patients, thus fulfilling element 2D and clear documentation about the care practices are provided to comply with element 2C.
Standard III: Population Health Management
This standard focuses on an entire population rather than individual patient care. The intention is to use the available patient information to manage the health of the practice’s entire patient population. The practice must set up a searchable electronic system that honors race, ethnicity, and language. Further, the practice reminds patients of their appointments and other care practices via a clinical decision support and electronic systems. The standard is made up of five elements, including element 3A: patient information, element 3B: Clinical data, element 3C: comprehensive health assessment, element 3D: use data for population management and element 3E: implement evidence-based decision support (Strange et al., 2010). The clinical data information must be well documented to ensure that other physicians who might need to attend to the patients understand it. The comprehensive health assessment data is analyzed and updated regularly to allow the practice to serve the population in a better way (Green et al., 2012). The care practices chosen to address the population health problems must be evidence based and their effectiveness in handling such cases must be previously tested.
Standard IV: Care Management and Support
The fourth standard identifies patients for care management. The patients chosen might be older patients, people with complicated situations, and those at risk of developing preventable illnesses. A practice must fulfill element 4A to become compliant with the fourth standard of the PCMH. Element 4A is identifying patients for care management (Strange et al., 2010). This element can be achieved by analyzing the social determinants of health in the environment and their effects of individual wellbeing.
Standard V: Care Coordination and Care Transition
The most important element that a practice must fulfill to comply with the fifth standard is element 5C: coordinate care transition (Donohue & Maragakis, 2015). The practice must have a process that identifies patients who are admitted to target facilities that used to serve the patient population of the practice. The aim of the standard is to ensure that a practice coordinates with the available healthcare facilities in the area to offer the required care to the patients (Fifield et al., 2013). Coordinated care ensures that patients are served at all times even when the practice does not have enough work force to handle the clients’ needs.
Standard VI: Performance Measurement and Quality Improvement
The element that a practice must fulfill to comply with the sixth standard of the PCMH is element 6B: measure resource use and care coordination (Donohue & Maragakis, 2015). The practices are supposed to measure resource use annually and document how care was coordinated after every period. The practice chosen for each period must be directly linked to the resources available. The practice can use this information in deciding the other practices to coordinate with to improve the quality of care. An assessment of the referrals is also important in improving the quality of care (Strange et al., 2010). The practice follows up on the services offered to the patient and the satisfaction level of the client. The information helps a practice to maintain helpful coordination and to drop facilities that do not offer satisfactory services to the referred patients
The PCMH is an ideal model that can bring the transformation of primary care services if embraced in different practices. The model works for both small and large practices and it is ideal in the improvement of quality and the reduction of the cost of care.