Patient Centered Medical Home

Overview of the Patient Centered Medical Home project piloted by Geisinger Health System in Danville, Pennsylvania

The licensed practical nurse shows client centered care in many ways. Bell (2014) states, “The goal of patient-centered care is to see the patient and family as a

What is a patient medical home? A patient medical home is a model of care designed to foster a partnership between the patient and the physician. The New York State has adopted the medical home standards of the National Committee for Quality Assurance (NCQA). The National Committee for Quality Assurance (NCQA) defines a patient medical home is "a model for care provided by physician practices aimed at strengthening the physician-patient relationship by replacing episodic care based on illnesses and patient complaints with coordinated care and a long-term healing relationship.” The NCQA is a private, 501(c) (3) not-for-profit organization founded in 1990. The organization is dedicated to improving health care quality.

Patient- centered care focuses on seeing things through the eyes of the patients and including them in all decisions based on their needs and value and placing them first. Patient centered care is including the patient in their care. The care is based on a healing perspective and not just caring. Relaying information so that patient/ family can understand it because patients may be in pain, fear or uncomfortable and may not understand the information relayed. An example

PCMH is an approach to providing comprehensive primary care to adults, youth and children. PCMH will broaden access to primary care, while enhancing care coordination. Its principles are collaborative care, patient- driven, utilization of a pharmacist, efficient, continuous care to acute, chronic, preventive, and end of life care, flexible, measurable outcomes, aligned payment policies.

8. Patients need to be involved in all actions of care to create the best care possible. Foster patient responsibility by initiating regular checkups and appointments for the patient. Instigation and establishment enhanced communication system, provision of adequate information for patients and caregivers on healthcare to improve the patient outcomes (Uhl et al. 2013). Patients should be involved in planning of their care to ensure the smoothest compliance with the set care

Professional associations, payers, policy makers, and other stakeholders have advocated for the patient-centered medical home model. Interventions to transform primary care practices into medical homes are increasingly common, but their effectiveness in improving quality and containing costs is unclear.

The patient- centered medical home is designed to improve quality of care through a team-bases coordination of care, which would treat the majority of a patients needs at once by increasing access to care and empowering patients to be a part of their own care (U.S Department of Health and Human Services, 2014). In order for these homes to work, the authors suggest that specialists might be the best candidates to certain conditions, however for these specialist to function in the capacity that is needed in these medical homes, they would have to have interest and proficiency to manage other conditions that fall outside of their

Patient-centred care also referred to as person-centred care. Relates to treating an individual receiving healthcare with dignity and respect also including the patient in all decisions about their health outcome. The principles for patient centred care for all health professionals involves respect for patient’s preferences and values, emotional and physical support, education, continuity, coordination of care, and involvement of family and friends. Many health professionals including general partitioners, pharmacists and resisted nurses, focus on embedding patient-centred communication principles in health practice, which is important as there is a lot of uncertainty with patients. The type of communication approach conveys the effectiveness of

Patient-Centered Medical Homes (PCMH) are growing in popularity as the right thing to do improve patient care. PCMH are growing in popularity, as there is early evidence of their effectiveness (Egge, M. 2012). The PCMH concept has been widely promoted as a way to enhance primary care and deliver better care to patients with chronic conditions. This model of care has stimulated the attention of payers, Medicaid policy makers, physicians, and patient advocates, as it has the potential to address several of the limitations of the current healthcare system (Wang, J. et al 2014). Currently, primary care in the United States is focused on acute and episodic illness, it inadvertently limits comprehensive, coordinated, preventive and chronic care (Bleser, W. et al 2014). The PCMH address these limitations through organizing patient care, emphasizing team work, and coordinating data tracking (Bleser, W. et al 2014). A PCMH and HMO have some similarities but are markedly different.

The author has been employed in the healthcare field for over fifteen years that has allowed the time to observe the transformation of the primary care practice. This paper will examine the industry using Aspirus, Inc. as the reference point; however encompassing an examination of other healthcare institutions. Evidence suggests the Patient Centered Medical Home (PCHM) model, also known as the medical come, of care can offer many benefits, including improved quality in the patient experience and disease management and lower costs to the patient and system because of reduced emergency room visits or hospital admissions. The main objective of this paper is to highlight the challenges and explore what the PCMH model will be like in five years within the primary care setting of a healthcare organization.

Communication is key to effective healthcare practices. According to American Journal Of Critical Care (2014), Patient-centered care starts with “effective communication, being empathetic and available, avoiding personal prejudges, and listening therapeutically are integral parts of patient-centered care” (Riley, White, Graham, Alexandrov, 2014, p. 320). This will improve communication; promote patient involvement in care, which creates a positive relationship with the healthcare provider and medical team. This results in improved adherence to treatment plan. Clinical practice guidelines need to be implemented for the patient and family members to be able to be involved in informed decision-making regarding healthcare needs. The fundamental core of nursing is to have a partnership with the patient and their family regarding the patient’s outcome.

One of the aims of the Patient Protection and Affordable Care Act (ACA) of 2010 is improved integration and coordination of services for primary patient care. The patient-centered medical home (PCMH) is one of the approaches by which improvements can be established. The patient-centered medical home model is particularly well-suited for people who have chronic illness. The design of the patient-centered medical home model departs substantively from traditional reimbursement policies, in that, the ACA provides for incentives and resources to enable care coordinators to be directly recognized and compensated for their care coordination work. Care coordinators are most often registered nurses who through their work that aligns with ACA engage in quality improvement work, cost-effectiveness measures, and patient advocacy. To bring the ACA model to a human scale, the authors present a case study of a care coordinator at a patient-centered medical home in rural Maine. The table provided below provides a basic textual analysis of the study as it is published in the professional nursing journal.

There are five core competencies needed for health care professionals and they are provide patient centered care, work in interdisciplinary teams, employ evidence based practice, apply quality improvement, and utilizing informatics. In this paper, I will go into further detail how providing patient centered care is challenging, how to overcome the challenges, how it relates to my chosen profession, and how this competency can impact delivery of care to patients.

Having these elements is pertinent for both models, however a difference is that the patient- centered medical home model does not require that patients “get permission from a primary care doctor to see a specialist” (Patient-Centered Medical Home, 2007) however they are required to have a promising relationship with their primary physicians who can advise on what kind of special care is in need and what specialist can advise them in the best medical care and with the best decisions.