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The patient-centered medical home (PCMH) model means different things to different people. Joseph E. Scherger, MD, MPH, asks if PCMH is really the new model of medical practice.
The patient-centered medical home (PCMH) model means different things to different people. All agree that PCMH practices provide care coordination of patients and PCMH-certified practices a care coordinator. PCMH practices have information systems, usually electronic health records with a registry function, that allow the practice to look at groups of patients. Aggregating patients such as those with diabetes or women over age 50 allows the practice to practice population management. Beyond these commonalities, PCMH practices have wide variations in major functions such as the number of patients a physician sees in an average day and his or her panel size.
The complexity and quality standards of primary care practice have changed greatly since the era when the brief office visit was the model of care. The tools of communication and care have also expanded in a new information age in which Internet applications and information technology have radically changed service industries, such as banking, travel, and shopping. Medicine has been slow to change its service model, especially since fee-for-service reimbursement continues to dominate. All that seems about to change as payment for value grows increasingly prevalent.
The outcomes of treating one patient at a time, reacting only to those who make appointments, are notoriously poor. To achieve better outcomes for a population of patients, practices need to use their databases to reach out to patients proactively. The entire staff is involved in care-giving and physicians are not expected to do everything. Communication and care for patients will extend beyond office visits to Web-based applications (in text and in video.) This may be called a PCMH, but in reality it is long overdue 21st century medical practice.
It is time to retire the brief visit, high-volume model of primary care and replace it with a PCMH model of care using new technologies and staff roles to achieve much greater efficiencies and better health for our patients.
Joseph E. Scherger, MD, MPH, is a family physician based in La Quinta, California, a member of the editorial board of Medical Economics and Medical Home News, and has spoken extensively on PCMH, currently managing an advanced medical home practice for Rancho Mirage, California-based Eisenhower Medical Center. Agree with Dr. Scherger that PCMH is the next big step in healthcare? Tell us at firstname.lastname@example.org.