Value Based Purchasing And Medical Home Models

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

Hospital Value-Based Purchasing (VBP) is part of the Centers for Medicare & Medicaid Services’ (CMS’) long-standing effort to link Medicare’s payment system to a value-based system to improve healthcare quality, including the quality of care provided in the inpatient setting. The program attaches value-based purchasing to the payment system that accounts for the largest share of Medicare spending, affecting payment for inpatient stays in over 3,500 hospitals across the country.

The fact that there are broad spectrums of services available within the Kaiser Permanente network makes it easier to coordinate patient care. For example the Northern California site has implemented programs that focus on five “imperatives of personal care”, which are: patients have to have a primary care doctor, they need to be able to see that physician, patients that call have a short telephone wait, patients should receive timely appointments and have a great care experience (Commonwealth fund June 2009). Care management definitely plays a crucial role in health care. When the patients needs are met and quality care is received the result is patient satisfaction and potentially cost saving for the organization. Patients not only have to deal with health issues, many experience challenges within their environment and certain limitations depending on socioeconomic status. Therefore , coordination of patient care is key to the success of any health care delivery system.

As the continued support grows the PCPCC, the health care sector is recognizing the role of the medical home model, Accountable Care Organizations(ACO), many entities are embracing the model and performing better. According to Center of Medicare and Medicaid, the medical home model shows that there is an improvement cost effectiveness, which helps practitioners deliver quality care and advanced approaches to care coordination, care teams, and chronic disease management. As evaluations of ACOs, integrated health systems, and the medical neighborhood continue, the Patient Center Medical Home will be essential to driving improvements in cost, quality, and outcomes. [3]

The Affordable Care Act was a major healthcare reform centered on providing affordable health insurance coverage to all Americans regardless of their socioeconomic background or prior medical conditions. Under the Affordable Care Act, community health centers have been expanded to play an increasingly significant role in meeting the needs of the many newly insured individuals (Proser, Bysshe, Weaver, & Yee, 2015). Community health centers follow a unique model of care delivery that uses multiple primary healthcare team members, including PAs to increase capacity, reduce barriers to care, and improve patient outcomes while attempting to reduce the costs of care (Proser et al., 2015).

The Patient-centered Medical Home (PCMH) will be assessed to evaluate the effectiveness of other health care organizations (HCOs) to compare and contrast values and mission. In addition, program cost-effectiveness will be examined considering health insurance providers and HCO. As a health care administrator, it is beneficial to truly understand the basis and goals of the PCMH to effectively execute the medical home model and successfully provide the best care for each patient.

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

The Patient-Centered Medical Home seeks to improve health system delivery through respect, coordination, and involvement of caregivers. The Patient-Centered Medical Home (PCMH) involves a team of nurses, legal consultants, pharmacists, therapists, insurance consultants, medical assistants, and physicians working together at one location to provide expert care in the health issues they are specialized to address. Team-based care is designed to make primary care meet the needs of patients by providing collaboration among medical professionals. Patient-centered care can potentially improve both clinical outcomes and satisfaction rates while improving quality of care and reducing costs (Rickert, 2012).

The title of this article is clear and appropriate, the article talks about how specialist are trying to become part of patient – centered medical homes so that they will be included in the healthcare reform and continue to grow inpatient care along with getting referrals and monies for the job that they do. Specialties also want to be part of the health team and build a relationship with the patient – centered medical homes.

Some of the likely direct benefit of better coordinated care would be; reduction in the need for acute care services such as hospitalizations and over utilization of emergency room. Developing coordinated medical homes to prevent, diagnose and treat disease early will save health care cost. Also, CMS estimates shows that, 45 percent of hospitalizations of dual eligibles from either Medicare skilled nursing facilities or Medicaid nursing facilities in 2005 could have been avoided if health care are well

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 patient centered medical homes (“PCMH”) approach “focuses on keeping people well, managing chronic conditions like diabetes or asthma, and proactively meeting the needs of patients.” According to the Arkansas Department of Health, chronic diseases like cancer heart disease or diabetes affect approximately over fifty percent of adult Arkansans. Yet chronic diseases are often preventable. The high rate of chronic diseases can partly be attributed health insurance coverage—“when people don’t have health insurance they tend to avoid seeing doctors. People

As the shift for HCOs is made to a PCMH model, the financial aspect also has to make a transition to accommodate to the changes. In recent years, there have been implementations of different payment and reimbursement options, health insurance programs, and the establishment of the Affordable Care Act (ACA). Between May 2009 and April 2012, one of the initial PCMH pilot programs was conducted in Colorado, appropriately named The Colorado Multipayer Patient-Centered Medical Home Pilot. More than 100,000 patients within sixteen internal medicine practices participated in the experimental PCMH model, using six different health plans (Harbrecht & Latts, 2012).

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.

Many people are confused about what the Healthcare Reform Act does. The act is fairly straight forward and it claims to better our healthcare within Michigan and the rest of the United States of America. The United States Federal Healthcare Reform uses a "building blocks" approach that starts with the health insurance system we currently have in place. The Healthcare Reform provides more people with access to health insurance coverage, set up mechanisms for consumers to shop knowledgeably for insurance, and establish legal protections for consumers. Improving the U.S. health care systems requires the pursuit of three aims: reducing per capita costs of health care, improving the experience of