“Patient-Centered” Patient-Centered Medical Homes

The Affordable Care Act (ACA) places a strong emphasis on illness prevention, promoting health, and management of chronic conditions. The Patient-Centered Medical Home (PCMH) has taken a front row seat in health nomenclature. For instance, In particular, the ACA requires some Medicaid enrollees to be in a “health home,” invests in primary care and family medicine, and initiates Accountable Care Organizations for Medicare.
While many are excited by the PCMH concept, providers and policy implementers are concerned that there is not a specific PCMH definition or a common understanding of what one is. Political task forces and major provider organizations are researching and discussing the specific requirements and goals that these entities should strive to achieve. But what if the answer is in our own backyard? For instance, when reforming a community clinic, why wouldn’t one start by asking what the community wants from their clinic?
At the North American Primary Care Research Group Meeting earlier this month, I met a few community physicians doing this type of patient engagement. They reached out to the community and asked them to sit on their redesign boards and to be active participants in the discussion of how the fundamental PCMH principals could be applied to their clinic.
One physician relayed his story of working with his community. When the providers in his clinic met alone, they decided that 48 hours was an adequate goal for returning a patient’s email. A patient had a very different opinion. She thought a few hours was even too long. She said that patients mainly contact their physicians when they are in need of an urgent medicine refill or if they have symptoms that aren’t quite concerning enough for the emergency room and that both of those situations deserve a quick response.
I found this idea very powerful because it is the beginning of a paradigm shift in medicine from the historical paternalistic patient-provider relationship to a new partnership in health. As a family doctor in training, I see a future where all community delivery systems (clinics, hospitals, or other providers) reflect the needs and values of the communities in which they serve. To do this, community involvement is key. Patient-engagement not only provides the clinic with effective quality improvement strategies, but also empowers the patients to take ownership over their local health system and over their own health.
For more information on patient-engagement in healthcare, please read Lansky, D. Patient Engagement and Patient Decision-Making in US Health Care. Foundation for Accountability. July 11, 2003. Accessed from www.gih.org/usr_doc/FACCT_Paper.pdf on December 2, 2010.
And for more on PCMH generally, I recommend checking out the PCHM page at HHS (http://www.pcmh.ahrq.gov/portal/server.pt/community/pcmh__home/1483), the Patient Centered Primary Care Collaborative (http://www.pcpcc.net/content/joint-principles-patient-centered-medical-home), and this nifty little video (http://www.emmisolutions.com/medicalhome/transformed/english.html).