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New ‘Homes’ for American Health Care?

The constitutionality of the Patient Protection and Affordable Care Act (PPACA) of 2009 will be decided by the Supreme Court late this spring, but the ultimate test of its worthiness may be how it – and the debate it has stirred – spurs reorganization of the nation’s health care system to contain costs and widen access.

One reorganization that the law seeks to nurture is the Patient Centered Medical Home (PCMH), a model of health care delivery that has gained adherents in recent years. Its comprehensive, coordinated approach purports to save money by promoting wellness, providing early detection and treatment and minimizing duplicative tests and services. The PPACA places strong emphasis on this new approach and moves PCMH toward center-stage by including funding for a demonstration project.

A “medical home” is not so much a physical location but, rather, as Benefits Magazine asserts, “a coordinated, interdisciplinary approach to health care delivery based on a patient’s individual needs” (October 2011). According to the Agency for Healthcare Research and Quality (AHRQ), an agency of the U.S. Department of Health and Human Services (HHS), the medical home “encompasses five functions and attributes:”

  • Comprehensive Care includes physical and mental health, prevention and wellness, acute care and chronic care and involves physicians, advanced practical nurses, physician assistants, nurses, pharmacists, nutritionists, social workers, educators and care coordinators.
  • Patient-Centered Care is oriented to the whole person and supports patients in learning to manage and organize their own care at the level the patient chooses.
  • Coordinated Care is managed across all elements of the broader health care system, including specialty care, hospitals, home health care and community service and supports.
  • Accessible Services are provided with shorter wait times for urgent needs, enhanced in-person hours and around-the-clock telephone and electronic access to the care team.
  • Quality and Safety is advanced through the use of evidence-based care, clinical decision-support tools, performance measurement and improvement and patient satisfaction response.

The AHRQ also recognizes the key role that developing health information technologies will play in operationalizing the PCMH concept. The agency further notes that significant expansion of the nation’s health care-providing workforce is required. In addition, it suggests that fundamental payment reform is required because current rates and reimbursements do not compensate for the additional time and attention necessary to achieve the PCMH standard of care.

As the legal wrangling and ideological debates over the PPACA show, reforming the American health care – a system that consumes about a third of the nation’s GDP – is no easy task. While the controversies rage, however, the law is already propelling deeper consideration of an initiative that struggled for attention and support under pre-PPACA market structures. Whatever happens with the law, Americans may gradually gain new “homes” for their health care management in the years to come.

[Steve Clark]

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