- The patient-centered medical home (PCMH) has been around for decades, making its mark on primary care across the country. However, as healthcare has begun to embrace value-based care and quality improvement, the PCMH has become a popular and established model to drive patient engagement and a positive primary care experience.
The patient-centered medical home is “a model or philosophy of primary care that is patient-centered, comprehensive, team-based, coordinated, accessible, and focused on quality and safety,” according to the Patient-Centered Primary Care Collaborative (PCPCC).
Per the Agency for Healthcare Research and Quality, PCMHs are defined by a set of five characteristics:
- Comprehensive care
- Patient-centered care
- Care coordination
- Accessible services
- Quality and safety
The PCMH is not a payment model and involves no financial risk. Instead, it leans on those above-mentioned principles to drive better patient care at a lower cost.
The philosophy states that if key primary care stakeholders – including primary care physicians, mental healthcare experts, chronic care specialists, and preventive care providers – collaborate around patient needs, the patient will remain healthier and cost the health system less money.
Although the PCMH is not a payment model, healthcare organizations seeking PCMH classification must meet a certain set of benchmarks. In 2008, the National Committee for Quality Assurance (NCQA) and partner programs developed PCMH accreditation systems.
Currently, those recognized with PCMH status must meet an agreed upon set of PCMH principles, undergo a site visit, and check in with NCQA annually. PCMHs must also make incremental improvements in key model tenets.
Each of the five core PCMH components requires a culture of patient-centeredness. However, some elements, such as patient-centered care, access, and quality and safety, require a stronger focus on patient engagement than the others.
Below, PatientEngagementHIT.com discusses the importance of patient engagement in the patient-centered medical home and highlights strategies for success.
Unsurprisingly, patient-centered care is the core concept of the PCMH. PCMH leaders must put the patient and their families at the center of all quality improvement practices to ensure success. PCMHs should deliver care that meets patient preferences, is sensitive to patients’ cultural norms, and highlights patient values.
“A fundamental opportunity for patient engagement relates to care of the individual,” AHRQ said in a 2010 white paper about patient engagement in the PCMH. “This requires active steps to elicit patient and family views and preferences, and to incorporate those views and preferences into a shared plan for care.”
PCMHs can employ patient feedback surveys, comment cards, or patient and family advisory committees to elicit patient feedback. Providers with strong communication skills can also find out from individual patients which care experiences are valuable to them and use that information to make large-scale or individual changes.
Strong patient-provider communication will also drive patient education, another important piece of the patient-centered care puzzle. Clinicians must educate patients and their families about their conditions, symptoms, care management plans, and the importance of preventive care.
“A patient-centered medical home also implies a commitment to seeking and valuing the voice of the patient and family in care decisions,” AHRQ noted in the white paper. “The medical home can help to build this relationship with the patient and family by giving information about how the practice works and discussing roles and responsibilities for both the patient and the health care team.”
Providers must be mindful of unique patient populations when supporting patient centricity, lest strategies do not resonate with certain patients. Providers can also leverage health IT to support self-care, education, and communication.
The second patient-centered tenet of the PCMH is offering accessible services. PCMHs should offer timely access to urgent care services, maintain extended office hours, and deliver telephone access for emergency care, according to AHRQ. Many PCMHs lean on telehealth to expand convenient access to care.
Patient access to healthcare is an important part of the general mission toward stronger patient engagement. When patients face barriers to care – whether financial, geographic, or otherwise – they are by default unable to fully engage with their health. PCMHs drive patient engagement by ensuring patients have a trusted, centralized location to visit.
However, AHRQ stated that it is not enough to set up various access points. Establishing an access point arbitrarily will not necessarily drive patient access. PCMHs need to pay attention to patient preferences when developing their convenient care options.
For example, a PCMH with a larger senior patient population may not do well to push telemedicine options – these patients may prefer to call and make an in-person appointment during off hours.
Conversely, a PCMH that services many pediatric patients who depend on their parents might find success with telemedicine. Industry experts tout telehealth as a helpful technology for busy parents because it facilitates nearly immediate care inside the home.
Understanding patient preferences about care access points takes patient centricity to the next level. PCMHs drive patient engagement by giving patients a strong network of caregivers and also improves the care experience by allowing patients to access care at a site that is preferable to patients.
Quality and safety
Although healthcare quality and safety are not explicit components of patient centricity, they are nonetheless integral to the patient-centered medical home.
AHRQ contended that PCMHs should consult with patients about their care preferences in order to drive quality and safety. Patient partnerships drive an understanding of the elements of care that are important to the patient and will help providers determine how to drive specific areas of quality improvement.
“Patient and family participation in practice improvement activities has been a critical component of the medical home model, particularly as originated in pediatric settings,” AHRQ said in its 2010 white paper. “Leaders from organizations that have involved patients and families in practice quality improvement or redesign testify as to its importance and positive impact.”
Strategies for involving patients in quality improvement include:
- Suggestion books
- Collecting patient/family input in educational materials
- Doing “walk throughs” with families for practice flow
- Discussing methods for shared decision-making
- Inviting patients to help interview prospective staff
- Conducting patient questionnaires about care values
- Patient and family advisory councils
Patients are also integral to fostering a culture of safety, AHRQ explained.
“There may be additional opportunities for patients and families to work with medical home teams to promote safety,” the organization said. “Studies show that patients can improve safety through informed choices, safe medication use, infection control initiatives, observing care processes, reporting complications, and practicing self-management.”
AHRQ said that providers must create an environment open and conducive to patient participation to foster patient input into safety. Often, patients are afraid or intimidated to offer feedback to providers to challenge providers on matters of safety.
It is important for the PCMH to develop an environment in which patients are true partners in care.
There currently is not much information by way of fostering patient safety collaboration. Some healthcare organizations are using health IT to allow patients to provide anonymous feedback or flag inaccuracies in their medical records, but these initiatives are just beginning and their effects have not yet been proven, AHRQ pointed out.
PCMHs have a lot of moving parts. These care models leverage strong health IT to make sure they are offering comprehensive care options and coordinating care appropriately amongst different members of the “home” and other acute care providers.
However, there are some other characteristics that put the “patient-centered” into the PCMH. Driving patient partnerships and serving preferences, extending convenient access to care, and consulting patients about quality care and safety are key for PCMH success.