Patient-Centered Medical Home

Introduction

Patient-Centered Medical Home (PCMH) is a fast-growing model of health care provider program in developed nations around the world. In the US, the National Committee for Quality Assurance (NCQA) recognizes the program. PCMH aims at outreaching communities that need primary health care services in their vicinities as opposed to the conventional norm of centralized healthcare provision at hospitals. However, the program is designed to offer specialized health services often targeting specific demographic components in a given population. For instance, various states in the US have PCMHs that are designed specifically for pediatric health care and the aged population. Additionally, some PCMH could be designed to offer healthcare to patients suffering from chronic diseases such as cancer, diabetes, cardiovascular, and other diseases.

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Target Population and Diseases

PCMH is a team-based health care services delivery model with the primary goal of achieving maximized health outcomes. The target population is children, youth, and adults. In this case, comprehensive primary care is customized for each targeted population. The program was initially started to offer medical services to patients with chronic and acute illnesses who cannot access conventional medical attention in mainstream healthcare facilities. However, the program shifted its focus to other medical services at the community level after being found successful in cutting the cost of health services and improving outcomes for patients.

Participating Payers and Insurance Products

Corporates and individual persons contribute to the program through donations and other social responsibilities. In the US, healthcare insurance programs play a critical role in the payment of healthcare services to patients (Summergrad and Kathol 108). This aspect enables the program to offer high-standard healthcare services to patients irrespective of their financial capabilities. Additionally, the government plays a crucial role in financing the healthcare programs at the community levels to have a healthy nation.

The primary insurance service provider in the PCMH is the CareFirst BlueCross BlueShield. This provider has two insurance products that are described as health plans, which are applicable in the PCMH. One of the products is the Health Maintenance Organization (HMO), which is often the least expensive. The other product is the Preferred Provider Organization (PPO), which is the most flexible as a patient does not require a referral to be attended (Herendeen and Deshpande 30).

Participating Providers and Reimbursement

Since PCMH is a team-based model, it comprises health care providers that help in handling the target population. Therefore, the program is defined as joint principles. PCMH was established with the effort of the American Academy of Pediatrics (AAP), whose main responsibility is to attend to children who need healthcare services. Historically, it is believed that the PCMH program was first developed by the American Academy of Pediatrics in 1967 as a Medical Home program. The program served as the central source of information about children in need of medical care and other special needs (Harrington 263). Later in 2002, the program was defined as PCMH after it was expanded after the adoption of strategies that enabled the delivery of family-centered healthcare services. These strategies aimed at providing every American with a personal medical home that provided acute, chronic, and preventive healthcare services.

Additionally, PCMH works jointly with the American College of Physicians (ACP) whose main responsibility is to offer high-quality training to healthcare providers. This move ensures that healthcare providers, who qualify to work in the program, have the necessary skills for delivering quality service to the patients. Moreover, PCMH works jointly with the American Osteopathic Association (AOA), which serves as the representative member organization of osteopathic medical physicians to offer training programs for osteopathic physicians. The association’s mission is to promote excellence in medicine, research, and delivery of quality healthcare facilities (Herendeen and Deshpande 30).

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Lastly, the American Academy of Family Physicians (AAFP) was founded to promote medical science and the art of family medicine in the US. AAFP is currently the largest medical organization. It has played a crucial role in improving the health of patients in both families and the communities by delivering services with professionalism and creativity as the core values. AAFP has played a key role in the establishment of the PCMH program that has personal physicians to the patients (Salzman, Collins, and Hajjar 23). It ensures that doctors are well trained to provide first contact, continuous, and comprehensive care to the patients.

The PCMH program has a reimbursement program for health care providers. The program is managed by the CareFirst BlueCross BlueShield, which offers health insurance products to individuals and corporates. Upon buying the insurance product, the client is advised to participate in the PCMH health programs that involve regular health checkups. Clients earn bonuses, which are redeemed to lower the cost of health services as well as reimbursement of funds to the providers upon earning specified points. The insurance provider uses the earned money for funding the PCMH, thus cutting the cost of the budget that is incurred by other providers through the reimbursement program (Heyworth et al. 784).

Result and Progress of PCMH Program

The PCMH program has been rated as one of the most successful health programs in the US. By understanding the benefits of treating patients by coordinating care among qualified physicians, the program has achieved its goals of maximizing health service outcomes for the clients. Besides, the program is monitored by improved technology systems that allow for the integration of services amongst numerous facilities and healthcare providers in a particular region (Bleser et al. 43). This aspect has enabled the program to maximize chances of delivering quality services through referrals and the ability to seek specialized assistance whenever needed. The program is growing fast in numerous regions within the US with the help of the federal government to attain universal care for all citizens. Additionally, some other countries have started to adopt the system. This aspect underscores the program’s success towards the attainment of universal healthcare to communities.

Conclusion

The PCMH program is a successful health program that has played a key role in the attainment of universal healthcare for US citizens. Governments face insurmountable challenges when offering high-quality health care services without special attention being given to community-based healthcare programs, which are accessible to the residents of a particular region. The PCMH program targets the entire population with attention given to each demographic segment to ensure that high-quality services are delivered. The establishment of the program was aimed at helping patients that suffer from chronic, acute, and other illnesses that demand specialized care treatments. However, by partnering with other providers, the program has shifted to non-specialized health care providers to take care of all patients in society.

References

Bleser, William, Michelle Miller-Day, Dana Naughton, Patricia Bricker, Peter Cronholm, and Robert Gabbay. “Strategies for Achieving Whole-Practice Engagement and Buy-in to the Patient-Centered Medical Home.” The Annals of Family Medicine 12.1 (2014): 37-45. Print.

Harrington, Nancy. Health Communication: Theory, Method, and Application, New York: Routledge, 2014. Print.

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Herendeen, Neil, and Prashant Deshpande. “Telemedicine and the Patient-Centered Medical Home.” Pediatric Annals 43.2 (2014): 28-32. Print.

Heyworth, Leonie, Asaf Bitton, Stuart Lipsitz, Thad Schilling, Gordon Schiff, David Bates, and Steven Simon. “Patient-Centered Medical Home Transformation with Payment Reform: Patient Experience Outcomes.” American Journal of Managed Care 20.1 (2014): 782-785. Print.

Salzman, Brooke, Lauren Collins, and Emily Hajjar. Chronic Disease Management: An Issue of Primary Care Clinics in Office Practice, Philadelphia: Saunders, 2012. Print.

Summergrad, Pazul, and Roger Kathol. Integrated Care in Psychiatry: Redefining the Role of Mental Health Professionals in the Medical Setting, New York: Springer, 2014. Print.

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