The Current Model of Primary Care

ABSTRACT

The current model of Primary Care is not adequate to provide consistent, quality care to increasing numbers of patients. The NCQA created the Patient Centered Medical Home Model as the next step in improving patient’s access to consistent, quality management of their care. Physicians, Pharmaceutical companies, Managed Care Organizations, Medicare and Medicaid all have a part to play in making this model work. Early results show improved access, decreased utilization of services and improved satisfaction by patients. Keywords: Patient Centered Medical Home, Primary Care Physician, Patient Care Neighborhood, Pharmaceutical, PCMH Requirements, Quality Improvement, Group Practices, Cost Reduction, Reimbursement, Electronic Medical Record and Improved Access.

Introduction

Access to healthcare is unsatisfactory to many patients, providers and HSO’s. The Patient Centered Medical Home Model (PCMH) provides the structure to make the necessary changes to access and continuity of patient care. Non-PCMH care is often fragmented and incomplete. Medical records are not fully available to all practitioners, there is no teaching or prevention and the patient does not have full access to the healthcare system. If a physician is out of town the patient is often directed to the ER for even minor care, however, the ER physician is often not aware of the patient’s full medical history. As a result, the ER is tied up with non-emergency cases. Patients approach healthcare in an “Emergent Mode”, meaning that they wait until a concern becomes a problem. The patients insurance or Medicaid/Medicare must pick up the tab for a non-emergent visit in an Emergency setting. If the patient is legitimately an inpatient, is ready for discharge, and the Primary Care Physician (PCP) is out of town, too many times the patient is kept inpatient or leaves against medical advice and bears the consequences. This reactionary utilization of healthcare does not serve anyone well. PCP’s are often overworked and reimbursement is at a lower rate than it is for specialists. PCMH model was developed to provide better access to care, better communication with the PCP, improve patient education, improve patient outcomes and lower overall healthcare costs.

The Patient Centered Medical Home Model

The Patient Centered Medical Home Model is a team based health care model led by a physician. It is an approach to providing comprehensive primary care for children, youth and adults. It has been established through efforts of the American Academy of Pediatrics, American Academy of Family Physicians, American College of Physicians, and American Osteopathic Association. The PCMH is comprised of four aspects. The first of which is the fundamental