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Ankota: Home Care Next Generation Blog

How Will the PCMH Model Work?

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By Jessica Chao

Jessica Chao is a health system pharmacy administration resident at Johns Hopkins Hospital. A former student at The Carey Business School, she has worked extensively with Sage Growth Partners CEO Don McDaniel and will serve as an occasional guest blogger.

Is patient-centered medical home just another name for a new model for primacy care practices? Yes and no. The reason why healthcare has been the headlines for the past few years is that the United States is facing a crisis. Components of this healthcare crisis include: poor reimbursements to primacy care services, shortage of primary care physicians, fragmentation of care, and lack of accountability.

But what are the causes and what the effects of the problems? We need to understand the causes in order to fix the problems and to understand why and how the patient-centered medical home model will work.

Problem 1: Fee-for-service model
The fee-for-service model reimbursement is dependent on the amount of services provided (i.e. number of diagnosis-related groups, procedures, and/or prescriptions). The inherent defect of the model is the dis-alignment of quality with care. As a result, we are living with the aftermath of this broken model such as wide income disparities among physicians (family physicians average $173,000 compared with specialties such as $391,000 for radiology and $419,000 for cardiology)[i]. 

Problem 2: Primary care physician shortage
According to a Kaiser Family Foundation report published in April 2011, 56% of patient visits in America are primary care, but only 37% of physicians practice primary care medicine, and only 8% of the nation’s medical school graduates go into family medicine.  With the number of Americans over age of 65 reaching to 19% by 2030 and a slowed population growth since the Great Depression, this is quite concerning when comparing at the population who requires healthcare the most compared with those able to provide the care[ii].

The concept of medical home needs to focus on three main components: (1) revolution in reimbursement incentives, (2) improvement in the quality of care, and (3) cost savings.  In the next few years, there will be many “medical home” models emerging.  The important part is to make sure the three components are present since the mode might differ.  In short, I don’t really care what they call it as long as our patients are receiving accessible quality care without burning their wallets and having to jump through 10 hoops to get their questions answered.

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Ankota commentary: There are several concepts including PCMH that are aimed at providing better care, more practively, with the objectives of improving results and reducing total costs. Variations on Patient Centered Medical Home models are already in use and many are generating impressive results, even despite a usual lack of automation. Pilots show that readmissions can routinely be reduced 10-30% using early screening and proactive care of chronic conditions. Pilots typically lack technology to support the necessary scale, but reductions in avoidable hospital admissions by as much as 40-50% are possible on a very large scale by leveraging technology that better manages Care Transitions, coordinates multiple providers and services, and helps them operate more efficiently. Ankota's technology enables Patient Centered Medical Home and other models that promise better outcomes and lower total costs to the system. Contact Ankota here to learn more about Care Transitions and PCMH technology:


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[i] Halsey, A. June 20, 2009. Primary Care Shortage May Undermine Reform Efforts. Washington Post.

[ii] USA Today. Economic crisis slows US population growth. February 16, 2012.http://www.usatoday.com/news/nation/story/2012-02-16/us-population-growth-slows/53157486/1

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