Quality of Care in the United States Health Care System has been the focus of much scrutiny in recent decades, as models have begun shifting from fee-for-service to value-based care payment models. Provider practices that operate within various insurance contracts and quality programs are responsible for not only providing quality, efficient, affordable care, but also demonstrating that they are doing so. Program participation, data sharing and attestations dominate day-to-day activities and require additional practice support to maintain.
In 2012, a review of Horizon Healthcare Services in New Jersey focused on the Patient-Centered Medical Home model as a way to coordinate services through the primary care provider’s office in order to foster collaboration, improve quality and decrease costs (Patel et al.). Through studies of primary care programs that use the patient-centered model, the authors noted the importance of additional resources and support for not only the patients but the population health staff caring for the patients. Patel et al. notes that the primary care setting is an essential avenue for this type of collaborative care because of the ability to coordinate services across the healthcare spectrum.
The National Committee for Quality Assurance (NCQA) created the Patient-Centered Medical Home (PCMH) Recognition Program “to identify medical practices that have invested in a model of care that puts patients at the forefront and where continuous quality improvement is a priority” (NCQA, n.d.). Across the country, healthcare groups are focusing processes six key components of PCMH, addressing the needs of the patient as well as putting steps in place to ensure collaborative efforts. Workflows must be developed, staff must be educated, and reporting capabilities are necessary to demonstrate progression towards target in each area. Initial recognition is extensive and annual maintenance of certification is required to demonstrate continuous efforts toward improvement.
While Patel et al. note that studies have not conclusively proven that participation in medical homes improves quality of care or reduces cost, the authors do note the opportunities that exist within the primary care spectrum, which can foster opportunities for more patient-centered approaches. To support such services, though, requires additional education, funding, and resources for the care delivery system as a whole. The authors concluded that developing incentives and support structures is key to the sustainability of this model.
From my perspective as a Quality Manager, this article resonates with what I see on a daily basis. The practices I work with are Patient-Centered Medical Homes and I am responsible for understanding each metric, and making sure that, as an organization, we are adhering to best-practice standards. As we review, update, and create workflows and policies, the focus is on whether they are patient-centric, and if not, why. There is a fine balance between making sure that the services provided meet program requirements, are valuable for the patient, and are clinically significant and meaningful to those providing the care. I agree with the authors of this article that part of the support needed for such programs needs to focus on the “non-monetary” aspects. Education and training, guides and resources, as well as efficient data sharing are key to creating, demonstrating and supporting the patient-centered model. Staff can provide care to patients at any time, but if they do not have the understanding, resources, or the ability to use data to track process, then the capabilities of care will be limited. I would like to see a more robust support system for quality programs like this, that involve providing ongoing education for providers and staff, as well as opportunities for resources. Teams that provide care management services to patients need to be able to feel that they can address the patient needs – whether they are physical, emotional, or social. Without resources, both the health care provider as well as the patient may not feel that the care provided is as comprehensive or effective as it could be.
The authors of this article have provided great insight into a patient-centered care model over time and draw noteworthy conclusions about the additional avenues that need to be explored in order to provide more comprehensive care for patients. As I continue to work toward this approach in my own job role, I look forward to future developments in programs such as this that can provide additional support to patients and health care staff.
References:
NCQA. (n.d.) Patient-Centered Medical Home Recognition. Retrieved February 9, 2023 from https://www.ncqa.org/employers/ncqa-programs-of-interest-to-employers/patient-centered-medical-home-recognition
Patel, U. B., Rathjen, C., & Rubin, E. (2012). Horizon’s patient-centered medical home program shows practices need much more than payment changes to transform. Health Affairs, 31(9), 2018-27. Retrieved from https://www.proquest.com/scholarly-journals/horizons-patient-centered-medical-home program/docview/1039467161/se-2
I enjoyed reading your summary on PCMH and learning your perspective on this type of care. I am new to healthcare and appreciate learning about new techniques and strategies to further help people and teams provide more well rounded care. I took a further look at the PCHM website and what you wrote about the six key components being implemented. If I have learned anything about how to further care for other people is that the plan used to help them matters just as much. The breakdown that NCQA created by putting customers truly at the front and showing ways to cut cost in facilities was useful to see. I like your perspective on the importance on focusing not just on aspects of monetary value and that the other tools like training and resources can make all the difference. I am starting to understand the pace of health care in the sense that technology can move quickly but reform in how care is provided and implementation of new techniques is what takes time. I am inspired that initiatives like this are thinking so big and really recognizing that the care of the employees is just as important as the patients.
Thank you for writing about this because it has taught me about an organization I never knew about and the steps they are taking to implement more well rounded staff and patient plans.
Hey Janina,
Thanks for your review – and welcome to the world of healthcare! There is absolutely so much more to it than I knew about until entering this side of it. But programs like PCMH are put in place as best-practice and are good guides. It’s just not always easy to support and maintain some programs, so having resources, training and data support available are extremely important. And you’re right – making sure employees have what they need is necessary to set the patients up for success. Good luck to you as you move through your career – just know it’s ever changing and evolving so you have to be willing to continue learning!
Layne