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| What is PCMH by ImageThink! |
When I introduce myself as the Kansas Patient Centered Medical Home (PCMH) Initiative Coordinator people often respond with “What is PCMH?” And “Why should I care?”
Okay, maybe they don’t ask the second question aloud, but I sense it’s what they are thinking.
So, how do I respond to hospital, long-term care, and nursing administrators as well as optometrists, family physicians, specialists, and other health providers in a simple manner that is meaningful? How do I respond to you?
I share my elevator speech… “The Kansas PCMH initiative can connect you with the resources you need to survive health care transformation.”
What are the key words they’ll remember? Perhaps it’s “survival” or “resources.” And with my elevator speech I have begun collecting stories of transformation and successful health outcomes that can be shared and used across our entire health care continuum. So, I’ll not only have “speeches” but also compelling stories. And we know that stories often paint a better picture.
What’s happening in Kansas
Kansas, not unlike many other states in the U.S., began demonstrating this model in limited format in July of 2011. The goal was to discover what does and does not work in the transformation in care delivery and to share those findings across the health spectrum. In Kansas, and through the Kansas PCMH Initiative, we are trying to learn specifically how staff, operations, finance, and culture is impacted by this shift in delivery. We want to uncover where costs savings can be realized and cost-neutral changes can be made in quality improvement. We want to deliver the tools for successful patient-centered care to patients and providers alike.
We know that by creating a learning community we will not only positively impact health care outcomes, but create more viable and sustainable models for the delivery of health in our state. Our goal is not to reduce competition but instead to enhance and grow free-market competition. We are taking an interdisciplinary approach to the Kansas PCMH community and have expanded our initial pilot into support for a broader Health 3.0 emphasis which I am pleased to say that Health Facilities Group, Merck, Bank of Kansas, Health Care Real Estate Group, and Concergent as well as other health-related entities play a vital part.
The PCMH model of care delivery
So what is the patient-centered medical home, or PCMH? PCMH is a health care delivery model based on the relationship between a patient and their personal primary care physician. The physician leads a health care delivery team dedicated to providing comprehensive and continuous care. The physician and their team is also responsible for facilitating effective communication between themselves and other health care providers – communication centered around better care, improve safety, and improved outcomes – for the patient.
With this model patients are held at a much higher level of responsibility for their own health. Community outreach plays a key role in behavior change and support. Family physicians and their teams will be expected to facilitate a higher level of communication with home health, hospice, long-term care, dentistry, mental health, hospitals, and other health providers that care for patients. We expect family physicians to work with employers to co-create health management opportunities for population health via registries and other educational opportunities.
For administrators and human resource directors in our health care facilities, PCMH means a shift in organizational structure that while worth it in the long-run for providers and patients alike, won’t be without its bumps and bruises along the way. Some employees will get on the bus. Some will leave at the next stop. And it will be challenging, as change always is. And this is one of the key roles that Kansas PCMHI can play in supporting transformation.
In short, PCMH has high expectations that can be met. But the change is not a little one. With PCMH we are changing a lot.
Financial impact
The thought process simply is that with PCMH and across the entire health care system, patients receive the right care at the right time, lowering their health care costs and improving overall health. Employers pay less for health care as their employees spend fewer hours out of the office. Physicians are paid appropriately for providing coordinated, on-going care.
Currently there is no “standard” model for PCMH. Thus we are using this window of opportunity to not only test models that are in demonstration in other states, but to refine what a sustainable, viable model focused on health outcomes can look like while reducing or containing costs. Some PCMH models reflect increased fee-for-service payments from payers during the demonstration phase to offset additional costs including staffing changes, training, and IT upgrades. Some models reflect a three-pronged approach including the increased fee-for-service, increased per member per month care coordinator fees, and rewards based on health outcomes. And with these demonstrations come opportunities for increased reimbursements for EMR implementation via Meaningful Use and accreditation (NCQA, PPC-PCMH, Joint Commission, etc.).
In Conclusion
Remember when I said that “The Kansas PCMH initiative can connect you with the resources you need to survive health care transformation.”? This is so very true. The Kansas Health Foundation, United Methodist Health Ministries, and the Sunflower Foundation have all led the way to create an initiative that can support you, health care providers, while helping you, health care consumers, with resources to do what we all want to do…survive.
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