Patient Centered Medical Homes are a big focus of today’s health care reform. While Patient-centered medical homes (PCHMs) have technically been around for a while (since 1967), they are gaining ground as the gold standard of medical care. Today’s PCMHs combine concepts of accessible, continuous, comprehensive, coordinated, and (of course) patient-centered care – ideals for creating a right to health.
In PCMHs, doctors and the patient’s team of health care providers are to encourage and help patients contribute to the discussion about their care and engage in self-care. And doctors are meant to start working as a team with nurses, nutritionists, specialists, mental health care providers or other professionals to coordinate their efforts and address all of a patient’s needs. They may even refer a patient to community resources to address other needs like housing or legal help. An entire team centered around, focused on, and working toward improving the health of a patient. (I can’t help but sing part of the theme song for the TV show “Scrubs” – I can’t do this all on my own. I’m no Superman.”)
From my perspective – PCHMs are an incredible tool to help patients. Put simply, having accessible, coordinated care with a team of providers who listen and consider all of a patient’s needs makes a huge difference in the ability of patients to get and stay healthy. Yet I’m confused as to why only now are we coming to this idea. When did patient-centered care become an innovation? Shouldn’t patient-centered care have always been a leading principle of health care? Why have we allowed our doctors, therapists, orthopeadic surgeons, dermatologists, ob/gyns, etc. to work so autonomously and leave us to hodgepodge together all our care on our own, imperfectly coalescing the advice we received from each provider to stay healthy.
Some practices created medical homes long before they were the popular catch phrase for coordinated care. Now, many more are jumping on board. Still the rhetoric around PCHMs is intriguing. How is it that taking care of a person and all their needs is suddenly a novel idea?
Perhaps the idea is evolving as we start to look at developing Accountable Care Organizations (ACOs) which are taking form as part of the new health care reform law? The idea being that ACOs include PCHMs as a way to develop shared responsibility among providers. (More to come on ACOs in another post).
Perhaps the idea is so popular because we are looking to those practices that already do this and seeing how successful they are – creating improving patients’ health (thus reducing health care costs)?
Perhaps we didn’t have the tools we have today to make PCHMs so accessible for providers? Today health information technology helps doctors connect with patients and other providers in ever more innovative ways such as e-prescribing, scheduling visits, making referrals, receiving test results electronically, and following up with patients after they’ve left the office.
Or maybe some just had too much trepidation and fear about providers losing autonomy and insurers losing control over paying for discreet episodes of care (ie – paying for a doctor visit vs. paying for a visit with your doctor, the nurse practitioner, and the nutritionist in the office as well as a follow-up phone call to check in with you in a medical home). In a medical home, no one provider is at the helm, all are responsible, and insurers or other payors have to re-think their payment systems.
I’m glad that more are finally espousing the benefits of and encouraging the creation of more PCHMs. Patient-centered care should have always been and should remain the focus of our health care system. To truly make this a system of care, providers have to come together and patients must be involved in their own care to have their needs met not just medically but in their lives as a whole. PCHM’s are one way to further our right to health by ensuring accessible, high quality care for every patient.