The Value of the Patient-Centered Medical Home

The Patient-Centered Medical Home (PCMH) is an approach to healthcare that is widely seen as a first step toward healthcare reform. The PCMH is usually a primary care office - family medicine, internal medicine, pediatrics or geriatrics - that serves as the hub for all a patient's medical needs. Focusing on the whole person, it provides continuous, comprehensive, coordinated care, establishing a partnership between patients and their personal healthcare team as part of an integrated medical neighborhood.

The PCMH emphasizes:

• Enhanced access, making it easier for patients to contact their personal healthcare team;
• Prevention and proactive management of chronic conditions, improving clinical quality and safety;
• Education to engage patients in their care to attain optimum health;
• A team approach to care; and
• Technology, such as electronic health record and patient registries, to facilitate information exchange, storage and retrieval.

According to the Patient-Centered Primary Care Collaborative, "Clinicians practicing in the highest level medical home will:

• "Take personal responsibility and accountability for the ongoing care of patients;
• Be accessible to their patients on short notice for expanded hours and open scheduling;
• Be able to conduct consultations through email and telephone;
• Utilize the latest health information technology and evidence-based medical approaches, as well as maintain updated electronic personal health records;
• Conduct regular check-ups with patients to identify looming health crises, and initiate treatment/prevention measures before costly, last-minute emergency procedures are required;
• Advise patients on preventative care based on environmental and genetic risk factors they face;
• Help patients make healthy lifestyle decisions; and
• Coordinate care, when needed, making sure procedures are relevant, necessary and performed efficiently."1

To enable medical practices to adopt these priorities and build the appropriate infrastructure, the PCMH model realigns payment to blend standard fee-for-service reimbursement, a monthly care-management fee and a bonus for meeting or exceeding quality outcomes. Theoretically, this compensation model will shift the focus of care away from acute, episodic care toward more comprehensive, holistic care. It will incorporate both lower costs and better outcomes for patients.

Few practices can achieve the transformation to the PCMH on their own. Most lack the time, expertise and resources to transform their care delivery methods. On-site coaching by quality-improvement experts shows them how to adopt new work flows, realign staffing, acquire and use new technology to its fullest extent, and make the culture change to a quality-driven mindset. Once attained, the new framework allows a practice to improve operations, incorporate quality approaches and increase patients' and care-givers' satisfaction with the healthcare experience.

The PCMH narrows the gap between today's fragmented healthcare system and tomorrow's integrated approach.

1. Patient-Centered Primary Care Collaborative., accessed Aug. 15, 2011.

Lisa H. Schneck, MSJ, is staff writer for HealthTeamWorks, a nonprofit medical-practice transformation company in Lakewood, Colo