Health Law Consulting Blog

Monday, October 14, 2013

Evaluating the Patient-Centered Medical Home Delivery Care Model

On October 10 through 11, 2013, I attended the National Committee for Quality Assurance (NCQA) Education program “Facilitating Patient-Centered Medical Home Recognition” held in San Diego, CA at the Hard Rock Hotel.  The program was very informative and instructive on how physician practices can prepare to become NCQA accredited as a Patient-Centered Medical Home (PCMH).   Faulk & Associates is working with several interested parties contemplating PCMH recognition.  However, the recurring theme I hear is “what are the financial benefits to becoming recognized as a PCHM physician practice?  Specialty physician practices want to know how they may be affected by PCMH recognized “primary care providers” (PCP) (i.e., will PCPs be less likely to refer patients to specialists)?

 What is a Patient-Centered Medical Home (PCMH)?

The patient-centered medical home (PCMH) is a model of care in which patients are engaged in a direct relationship with a chosen provider who coordinates a cooperative team of healthcare professionals, takes collective responsibility for the comprehensive integrated care provided to the patient, and advocates and arranges appropriate care with other qualified providers and community resources as needed.

PCMH practices develop multidisciplinary care teams to improve care coordination and care management of patient populations aiming to improve safety, efficiency and quality in patient care. By becoming a recognized PCMH, practices can improve care delivery and take advantage of private or public incentive payments that reward patient-centered medical homes. The Patient Protection and Affordable Care Act (ACA) offers enhanced federal funding to states for health homes serving Medicaid beneficiaries. Provider groups and healthcare organizations can visit their federal and state government and private insurers’ websites for information on funding and reimbursement initiatives.

Delivery system reform and the potential for shared savings available through programs promoted by the Center for Medicare & Medicaid Innovation (The Comprehensive Primary Care initiative, The Advanced Primary Care Practice Demonstration and the Advance Payment ACO Model) hold promise to further expand access to PCMHs for patients, specifically elderly, chronically ill and low income populations across the country.

Stay tuned as we explore some of the cost-savings and innovative reimbursement models that support PCMH in weighing some of the pros and cons of becoming recognized as a PCMH.


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