Assignment 8 - Innovation and Challenge of the Patient-Centered Medical Home Model

Question 1

a health care delivery practice that actively engages patients in care and provides coordinated and integrated care; such a practice is equipped with an integrated health information technology system and supported by an appropriate payment arrangement that recognizes the added value of patient-centered components.

Answer 1

patient-centered medical home - A PCMH

Question 2

The concept of PCMHs is woven into the Patient Protection and Affordable Care Act (ACA) of 2010 and is broadly defined in

Answer 2

section §3502

Question 3

While it aims to engage patients and their providers in a collaborative partnership that places the patient at its focal point, the PCMH is not an entirely new concept. The American Academy of Pediatrics originally introduced the concept of the medical home in ____ as a coordinated-care model for children.

Answer 3

1967

Question 4

Following the passage of the ACA, how pervasive has the usage of PCMHs been in the delivery of health care services?

Answer 4

particularly robust

Question 5

A patient can be said to have a “medical home” if he or she has a _____ who provides a first point of contact, as well as ongoing, comprehensive and coordinated care that moves away from the traditional _____ gatekeeper system.

Answer 5

personal physician

referral-based

Question 6

The PCMH model has a few basic features that distinguish it from the traditional care delivery model: (3)

Answer 6

• integration of health information technology
• patient-centered engagement in care
• a team-practice approach.

Question 7

One nonprofit organization, the ______ , is the main organization involved in PCMH recognition.

Answer 7

National Committee for Quality Assurance (NCQA)

Question 8

The NCQA’s recognition criteria for status as a PCMH are aligned with the PCMH definition in the ACA. In § 3502 of the ACA, a PCMH is defined as a mode of care with six core features, including the use of personal physicians;

Answer 8

1. a whole person orientation
2. coordinated and integrated care
3. safe and high-quality care through evidence informed medicine
4. appropriate use of health information technology and continuous quality improvements
5. expanded access to care
6. payment that recognizes added value from additional components of patient- centered care.”

Question 9

For PCMHs, the _____ and other technological components are fundamental.

Answer 9

electronic health record

Question 10

The ______ is another key element of the medical home concept. In order to build long-term relationships with patients, practices must adapt to patient needs and focus on access and patient involvement in care, including steps toward self-management of diseases

Answer 10

“patient-centered focus”

Question 11

One of the key differences between medical homes and the traditional gatekeeper model is that PCMHs institute a:

Answer 11

• team approach to patient care.
  
  • (it is common to have daily team “huddles” to preview cases, review lab results and coordinate the expertise of necessary team members. )

Question 12

The logic behind the team approach in medical care delivery at a PCMH is that

Answer 12

a patient may require more resources per visit but will necessitate fewer visits in the long run

Question 13

The future success of PCMHs will depend on finding the right mix of payment options to adequately compensate staff and induce the right incentives. What payment approach elements are typically blended in a PCMH reimbursement method? (3)

Answer 13

• (1) A monthly care coordination payment supporting the medical home structure to provide predictable funding for practices;
• (2) A visit-based fee-for-service component relying on the current volume-rewarded system to give practices an incentive to provide services;
• (3) A performance-based component that recognizes the achievement of quality and efficiency goals to encourage practices to improve quality and efficiency.

Question 14

The information technology component of medical homes dovetails with the federal meaningful use standards, creating a virtuous cycle. The three stages of meaningful use require that providers:

Answer 14

1. utilize a certified electronic health record system in a substantive manner
2. meet a number of objectives
3. exchange of health data, along with reporting of quality measures.

Question 15

Among medical homes, there is a wide range of _____ in practice setup. Requirements for PCMH funding through PCMH pilots are purposefully vague in order to encourage provider ____ & ______, but model inconsistency could be a major setback for long-term adoption.

Answer 15

• variability
• adoption & innovation

Question 16

There are three major state and federal initiatives run by the Centers for Medicare and Medicaid Services to encourage practices that are currently covering millions of patients and thousands of providers to adopt the PCMH model. These demonstration projects are major tests of the PCMH model.

Answer 16

1. The Federally Qualified Health Center PCMH demonstration includes 500 practices
2. Multi-Payer Advanced Primary Care Practice demonstration in eight states
3. Comprehensive Primary Care Initiative is run by the Center for Medicare and Medicaid Innovation.

Question 17

• This project is tasked with establishing, funding and evaluating medical home pilots.
• is investigating whether the medical home can truly achieve coordinated, higher quality care at lower cost in order to meet the goals of the ACA.

Answer 17

Multi-Payer Advanced Primary Care Practice.

Question 18

• will take place over four years and is being implemented across seven states with 500 practices, which will provide care for about 313,000 Medicare beneficiaries in total.
• is offering $20 per enrollee per month in addition to customary fee-for-service charges; the monthly payment will be reduced to $15 for years three and four of the pilot, but there will be opportunities for provider compensation in the form of shared savings.

Answer 18

The Comprehensive Primary Care Initiative demonstration project

Question 19

this program will reach 500 FQHC’s throughout the United States, which amounts to 195,000 Medicare beneficiaries. Practices will follow the criteria for recognition and receive a monthly payment of $6 per patient enrolled in the practice to help offset the costs associated with transformation;

Answer 19

Federally Qualified Health Center Demonstration

Question 20

There seem to be a number of qualities that allow the medical home to achieve impressive cost savings through coordinated preventive care. Successful practices construct an integrated, informed circle of clinicians who constantly assess and engage patients. When the practice is operating as envisioned, patients: (3)

Answer 20

• receive timely appointments
• understand their plan of care
• take the initiative for preventive measures,

Question 21

Do ACA demonstration projects, existing guidelines and the standards promulgated by recognition bodies provide enough impetus for encouraging adoption of PCMHs on a national scale?

Answer 21

no, not yet

Question 22

What areas seem to need improvement in order to achieve the desired potential offered by PCMHs? (3)

Answer 22

• funding methodology.
• expected timeline for transformation.
• variation in reimbursement methods and medical home setups

Question 23

Despite the issues and limitations, why do PCMHs, or a variation on their conceptualization, appear to hold promise for patient care going forward?

Answer 23

It effectively integrates information technology with a focus on primary care