Patient Centered Medical Home – A Key Element of Effective Healthcare Reform

03 January 2012

Some of the principles that describe a PCMH include each patient having an ongoing relationship with a primary care physician as well as a care team to provide first contact, continuous, and comprehensive care; holistic care that includes acute, chronic, preventative, and end of life care; and care that is coordinated and integrated across all elements of the complex health care system. A PCMH is customer-driven, meaning patients are engaged and participate in decisions about their own care. Information Technology is used to collect and analyze data to advance primary care practice within the PCMH and connect to community networks that extend resources for care.

In layman terms, this means better care with a doctor who knows you within a health center to call home.

Currently, the federal government is implementing several strategies to advance the PCMH, including funding a large number of research and technical assistance activities to assess health centers’ current “health home” status. Centers for Medicare and Medicaid Services are developing demonstration projects that will test and evaluate advanced primary care models of care delivery and payment. This period of research and evaluation will be critical since by 2013, incentives will be provided for state Medicaid to cover evidence-based preventive services and there will be a national pilot on payment bundling to increase collaboration and improve coordination of care.

Once the ball drops in Times Square welcoming in 2014, Medicaid (known as Medi-Cal in California) will expand to all individuals under age 65, with incomes up to 133% of Federal Poverty.  This coverage expansion will add as many as 2 million people to California’s 7 million person Medi-Cal program.

Between now and 2014, the healthcare system and payment model must undergo some transformation in order to appropriately care for all of these new patients. The leaders of Healthcare Reform believe that the PCMH model will provide just that: improved healthcare for patient through both increased continuity of care and greater access to necessary services.

Sarah Scher is the Director of Community Affairs and Finance at Community Clinic Consortium, which is a partner of SCBH

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