The Patient-Centered Medical Home: Will It Stand the Test of Health Reform?

Department of Family and Community Medicine and Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, USA.
JAMA The Journal of the American Medical Association (Impact Factor: 30.39). 06/2009; 301(19):2038-40. DOI: 10.1001/jama.2009.691
Source: PubMed

ABSTRACT The fundamental challenge for health care reform in the United States is to expand access to all US residents, while rapidly reengineering the delivery system to provide consistently high-quality care at lower overall cost. Current reform discussions recognize that success will require a shift in emphasis from fragmentation to coordination and from highly specialized care to primary care and prevention.One prominent model of delivery system reform is the patient-centered medical home (PCMH). Crafted by the primary care professional organizations in 2007, the model has been endorsed by a broad coalition of health care stakeholders, including all of the major national health plans, most of the Fortune 500 companies, consumer organizations and labor unions, the American Medical Association, and a total of 17 specialty societies.1 Currently, 22 multistakeholder demonstration pilot projects are under way in 14 states, and the Centers for Medicare & Medicaid Services will conduct Medicare demonstration pilot projects in 400 practices in 8 regional sites in 2009.2- 3 Twenty bills promoting the PCMH concept have been introduced in 10 states.4

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    • "In addition, despite the fact that organizational solutions might vary according to the context, all of them tend to have GPs working in collaboration with other health care professionals (e.g., nurses, specialists) with the aim of organizing processes of care that are patient centered, generate a prompt and appropriate response to most common problems, avoid inappropriate and inefficient admissions to the hospital, and improve clinical outcomes (Berenson et al., 2008). The current discussions in the United States about patient-centered medical homes clearly testify to the relevance of the topic and the widespread experimentation and evaluation that is being performed with these organizational arrangements (e.g., Crabtree et al., 2011; Jaén et al. 2010; Rittenhouse & Shortell, 2009). Numerous indicators and indexes have been devised to measure the extent of implementation of the medical home model in primary care practices (Cooley, McAllister, Sherrieb, & Clark, 2003; Gilfillan et al., 2010; Jaén et al., 2010; Reid et al., 2009; Rittenhouse, Casalino, Gillies, Shortell, & Lau, 2008; Rittenhouse et al., 2011). "
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    ABSTRACT: Multiprofessional primary care models promise to deliver better care and reduce waste. This study evaluates the impact of such a model, the primary care unit (PCU), on three outcomes. A multilevel analysis within a "pre- and post-PCU" study design and a cross-sectional analysis were conducted on 215 PCUs located in the Emilia-Romagna region in Italy. Seven dimensions captured a set of processes and services characterizing a well-functioning PCU, or its degree of vitality. The impact of each dimension on outcomes was evaluated. The analyses show that certain dimensions of PCU vitality (i.e., the possibility for general practitioners to meet and share patients) can lead to better outcomes. However, dimensions related to the interaction and the joint works of general practitioners with other professionals tend not to have a significant or positive impact. This suggests that more effort needs to be invested to realize all the potential benefits of the PCU's multiprofessional approach to care.
    Medical Care Research and Review 07/2014; 71(4):315-336. DOI:10.1177/1077558714536618 · 2.57 Impact Factor
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    • "An engaged patient is essential for delivery models focused on chronic disease treatment and prevention of health risk behaviors such as the Chronic Care Model [4] [5]. Also clinical models such as the patient-centered medical home [6] highlight the importance of enabling an accessible and responsive care system, care coordination and an effective communication with the health providers in order to promote patient engagement and achieving increasing rates of treatment adherence, thus improving patient health outcomes and reduced costs of care. Engaging people is considered critical to understanding their experience of health and care; this, in turn, can lead to patient centered changes in practice and service delivery thus augmenting the quality of care [7] "
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    ABSTRACT: Academic and managerial interest in patient engagement is rapidly earning attention and becoming a necessary tool for researchers, clinicians and policymakers worldwide to manage the increasing burden of chronic conditions. The concept of patient engagement calls for a reframe of healthcare organizations' models and approaches to care. This also requires innovations in the direction of facilitating the exchanges between the patients and the healthcare. eHealth, namely the use of new communication technologies to provide healthcare, is proved to be proposable to innovate healthcare organizations and to improve exchanges between patients and health providers. However, little attention has been still devoted to how to best design eHealth tools in order to engage patients in their care. eHealth tools have to be appropriately designed according to the specific patients' unmet needs and priorities featuring the different phases of the engagement process. Basing on the Patient Engagement model and on the Positive Technology paradigm, we suggest a toolkit of phase-specific technological resources, highlighting their specific potentialities in fostering the patient engagement process.
    Studies in health technology and informatics 01/2014; 199:13-21.
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    • "The Patient Protection and Affordable Care Act (ACA) includes several provisions that bolster the supply of primary care physicians and subsidize receipt of primary care. Underlying this policy is the belief that primary care is preventive and cost reducing (see, for example, Starfield et al. 2005; Rittenhouse and Shortell 2009). In addition, the expansion of health insurance coverage, which is also a prominent part of the ACA, is often justified with references to the cost-effectiveness of primary care, which is known to increase among newly insured persons. "
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    ABSTRACT: By exploiting a unique health insurance benefit design, we provide novel evidence on the causal association between outpatient and inpatient care. Our results indicate that greater outpatient spending was associated with more hospital admissions: a $100 increase in outpatient spending was associated with a 2.7% increase in the probability of having an inpatient event and a 4.6% increase in inpatient spending among enrollees in our sample. Moreover, we present evidence that the increase in hospital admissions associated with greater outpatient spending was for conditions in which it is plausible to argue that the physician and patient could exercise discretion.
    Journal of Health Economics 07/2012; 39. DOI:10.1016/j.jhealeco.2014.08.003 · 2.25 Impact Factor
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