The PCMH model of Care Delivery: Are We Leveraging it Properly?

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Abhinav Shashank
Fri 11 Oct 2019
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PCPs are supposed to be the first touchpoint for patients in the healthcare system, and they often wear multiple hats, a genuinely rare trait that most of them seem to enjoy. However, more often than not, they do not achieve the desired outcomes for completely no fault of their own. They simply do not have enough bandwidth to talk at a stretch with their patients. 

Healthcare organizations need to focus on their primary care facilities

For every 100 physicians in the US, 32 are PCPs. On the other hand, for every 100 patients in the US, 52 patients visit a PCP each month. There is clearly a gap which we need to address. Lack of enough physicians at a primary care level can result in increased visits to specialists and EDs, thus increasing costs.

According to an estimate, up to 27% of ED visits may be avoidable, a number that clearly depicts the lack of care coordination and inadequate access to care facilities at the right time.

How does the PCMH model of care bring a revolutionary approach to care delivery?

Patient-Centered Medical Homes, often abbreviated as PCMH, model puts patients and PCPs at the forefront of care. Organizations under this model offer comprehensive, coordinated, and accountable care.

PCMH facilities are focused on ensuring wellness rather than just treating diseases. Such facilities tend to have a dedicated physician who looks after most of their care needs. To take care of all their care needs, they can also have access to services such as behavioral health within the same facility. The care staff is equipped with comprehensive information regarding patients’ health at all times that allows them to act in a prompt manner.

The PCMH model is essentially built on the following widely-accepted promises:

  1. Access to care
  2. Comprehensive care delivery
  3. High-quality coordinated care
  4. Cost-effective care
  5. Patient-centered care

In theory, PCMH models offer everything that our healthcare system has been trying to achieve for many years.

Making patients healthier and happier: The PCMH way

Baby boomers, millennials, middle-aged people, and kids― everyone has different needs and expectations. However, every patient longs for comfortable, connected, and cost-effective care.

Delivering quality care within the primary care facilities can reduce unforeseen health emergencies to a great extent. For instance, care coordination and its various domains at a primary level― transitional, chronic, and post-acute, among others― hold the potential to improve care and cost outcomes drastically. The more PCPs know about their patients, the easier it gets to impart care in a much more personalized and evidence-based manner, thus reducing the chances of missing out on degrading patient health.

However, making things easier for patients shouldn’t come at the cost of frustrated PCPs. Provider and patient satisfaction are, in fact, interdependent. For instance, while it is important to ensure that there are little or no skipped appointments and at the same time, calling patients to remind them of their scheduled meetings should be the least of providers’ concerns. With a technology-driven care model, PCMH can achieve such outcomes seamlessly.

One way of doing it is by providing every detail about their patients available in the PCPs’ workflows in a simplified manner. Their minds should only focus on treating patients; everything else should be automated. In other words, we need to free PCPs from anything and everything that doesn’t involve providing care.

The road ahead

No technology can succeed if it does not make the lives of its targeted segments, i.e., patients and providers, easier. While organizations need to develop a data-driven approach to improve the quality of care across the network, sustaining the human element in the healthcare space is something that all leaders should focus on.

At a broader level, organizations should aim at developing a comprehensive care delivery model that coordinates care across all elements of the healthcare system, including hospitals, specialty care, community services and supports, and home health care, among others. Patients who are more aware of their well-being tend to take their symptoms more seriously and reach out to their providers more proactively. Such promptness ensures timely access to care and provides better communication in each instance. It further sums up to reduced utilization and better care outcomes.

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Abhinav Shashank
The PCMH model of Care Delivery: Are We Leveraging it Properly?
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