Chris Apostol, DO

	I entered family medicine 15 years ago, convinced that I could heal not just my patients, but health care.  Primary care physicians are this country’s comprehensive caregivers - its eyes and ears for total health.  We offer our patients long-term relationships in a system that often favors an episodic approach to coordinated care.  I know that empowered primary care providers have the ability to create the highest levels of health and well-being this country has ever seen. But our country’s primary care infrastructure is under enormous strain. The idea of converting my practice into a patient-centered medical home (PCMH) came into focus as we, like many, struggled with flattening reimbursement, limited time with patients, and a payment system that rewards volume rather than value. As my practice applies for Level 3 recognition through the 

 (the highest level a practice can attain) this year, we’ve embraced PCMH not just as a stepping stone towards payment transformation but as a noble recasting of our essential care delivery model.  It is a radical shift, but one worth making.

	PCMH puts patients back at the center of care by surrounding them with a coordinated, comprehensive care team. PCMH is what health care "done right" looks like: effectively managed populations; enhanced patient care experience through access, reliability, and quality; and reduced unnecessary cost and utilization. By taking responsibility for their patients’ outcomes, these practices testify to the power of even the smallest practices to gradually bring about great change. More and more, financial incentives are being offered to those practices that have risen to the challenge, rewarding them for the value they create.

	There are other ways to experiment with quality outcomes and rewards, of course, but none that strike at the heart of a doctor’s vocation in quite the same way. Unlike accountable care organizations and shared savings  programs, which were designed expressly as alternative payment models, PCMH was invented as an alternative care model, and its requirements tap into not just performance and outcomes, but a practice’s ability to manage, coordinate, and support the basic pillars of health. Its tenets require that practices not only report on quality benchmarks but also prove their reliability, access, and ability to manage complex cases and transitions.

	Restructuring a practice into a PCMH is a big task requiring the reorganization of some of its most basic organization. How do you get providers thinking in terms of teamwork, to focus on outcomes, and to do it in a financially accountable manner? Do you have the funds to pay for care coordinators or quality program managers, or for midlevel practitioners? One overlooked question, but arguably one of the most important, is: How will your health information technology (IT) services support you?

	PCMH requirements are inherently IT-oriented, from the way an encounter is documented to how that patient can access it electronically. But this is a shallow approximation of the full value health IT has to offer for aspiring PCMHs. Intelligent, cloud-based IT supports communication, clinical decision-making, and patient engagement. Many other features of a PCMH, such as coordination and collaboration, are outlined in my practice’s cloud-based EHR, whose workflows are pre-validated by the NCQA to help us capture points towards formal recognition. Simply click a button, and our EHR prints out reports we can use to apply. Many practices have already invested in their EHRs because of the meaningful use program. Engaging in the PCMH recognition process is a critical occasion for physicians to reconsider how-and if-the IT tools they’re using are backed by the services necessary to help them thrive through industry change.

	At my practice, NCQA PCMH recognition has been powerful-for me and my colleagues-who feel that we are practicing at the tops of our license, and for our patients, who express record levels of satisfaction and demonstrable improvements in outcome. Others along the care continuum are taking notice and rewarding us for our efforts. Many private payers are contributing $2 to $3 dollars on a per member/per month basis for recognized practices. Beginning in 2018, Medicare will reward them with a 5% reimbursement bonus. To health care’s great surprise, practicing medicine humanely and judiciously can finally be lucrative.

	At its heart, the patient-centered medical home is a care model delivering on the core aims of primary care.  It is a way to make additional revenue while making a change for good-to help doctors do what they were trained to do, to create value for patients and the system, and honor it with incentives that continue to build a market for more sustainable care. If our staff is the heartbeat of our PCMH, then our IT tools are the skeleton. Together, they are creating a medical home that isn’t just a place for our patients to receive care: it’s a place where we give them the permission, power, and tools to care for themselves.

Dr. Chris Apostol is a Board Certified family physician in Evans, Georgia. His practice, the 

, is applying for Level 3 PCMH recognition this year. He uses the athenaClinicals product from athenahealth.

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Patient-centered medical homes can improve healthcare, but they depend on health IT solutions to make them a success.

Author | Chris Apostol, DO

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PCMHs put patients - and intelligent IT - at the center of care