The Medical Home – Will It Deliver On Its Promise?

The holiday season is fast approaching. Families are planning gatherings so they may share meals, stories, and traditions in the secure comfort of their homes. We all know what this "home" feels and looks like. No further explanation or definition is required because, to some extent, we have all experienced the warmth and support of a "family-centered home."

So what is this new "Physician Centered Medical Home" (PCMH) and why has it become the new buzz word in healthcare? Payors, purchasers, physicians, and patients are touting the PCMH as the transformative vehicle that will bring value and order to our current costly and chaotic (non-) system of care.

Coalitions, both locally and nationally, are proposing attributes and measurables that define the qualities and characteristics of a Patient Centered Medical Home. All seem to share descriptive terms such as primary care directed; strengthening the physician/patient relationship; care that is safe, accessible, continuous and comprehensive; clinical care standards that are evidenced based, measured and transparent; information technology driven efficiencies; and, a revised value added payment structure.

Although not intuitive, one can begin to get a "feel" for this new home. The PCMH represents a merging, a coming together, where the best of "old fashioned" care is joined with the technological advances available today. The end result is a blend of personalized care that family physicians have been providing for decades, together with greater ability to provide high quality, cost effective, comprehensive and continuous care to an activated group of patients. By capitalizing on new technologies, the patient and physician will be able to coordinate care as they navigate through an increasingly fragmented and complex healthcare system.

Although there is a strong emphasis on infrastructure in most descriptions of a PCMH, it is not, by itself, the hallmark of a Medical Home. A PCMH is a junction of innovative ideas, efficiencies, patient valued services, and continuous outcome improvements which are enabled and enhanced by IT and process change.

Upon reviewing the seven core principles of a physician centered medical home as defined by the Patient Centered Primary Care Collaborative (PCPCC), a coalition of large employers (IBM and Merck); primary care societies (AAFP, AAP, AOA and ACP); national health plans (BC/BS, UHC, Medicare); and patient advocacy groups (AARP); one begins to gain an insight into the essence of a PCMH.

Seven principles of a Primary Care Medical Home (PCMH) - (See Attachment):

1. Personal physician
2. Physician directed medical practice
3. Whole person orientation
4. Care is coordinated and integrated
5. Quality and safety
6. Enhanced access
7. Payment restructuring

Based upon these seven principles, NCQA has formulated discrete measures that define a PCMH for the purposes of granting a certification designation to select Patient Centered Medical Home pilots and initiatives.

From my twenty-five year perspective as a family physician and recently a medical group director, I believe that most primary care physicians agree that the current system is broken and not sustainable - not if we want to reverse the trend of paying more for declining quality, access, patient satisfaction and professional fulfillment.

Many physicians, both independent and employed, are looking for an alternative which offers an opportunity to "make my day easier." Easier not in the sense of devoting less time or energy into patient care activities, but by making their time and clinical activities more meaningful and directly relevant to improving the health outcomes of their patients. The transformative potential of the Primary Care Medical Home model holds such a promise.