Innovating with Patient-Centered Medical Homes and Accountable Care Organizations to Improve Healthcare

June 17, 2012
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With the close of the third National Accountable Care Organization (ACO) Summit in Washington, DC last week, it got me thinking about the Patient Centered Medical Home (PCMH) and ACO models.  Specifically, what are the differences and which is more appropriate for the future delivery of healthcare?

With the close of the third National Accountable Care Organization (ACO) Summit in Washington, DC last week, it got me thinking about the Patient Centered Medical Home (PCMH) and ACO models.  Specifically, what are the differences and which is more appropriate for the future delivery of healthcare?

As defined by the four primary care societies (AAFP, AAP, ACP, AOA), the Patient-Centered Medical Home is as an approach to providing comprehensive primary care as a health setting that facilitates a continuous relationship between patients, the patient’s family when appropriate, and the patient’s personal primary care physician.  The joint principles supporting this model include:

  • Personal physician – serves as the primary contact and coordinator of care for a patient.
  • Physician directed medical practice – is led by the personal physician who directs the practice team to ensure continuous, comprehensive patient care.
  • Whole person orientation – in which the personal physician arranges and oversees care throughout patients’ various stages of life.
  • Care is coordinated and/or integrated – by the personal physician in connection with specialists and across settings facilitated by information technology and other appropriate tools.
  • Quality and safety – serve as primary guideposts for all aspects of a patient’s medical care.
  • Enhanced access – using tools such as open scheduling, extended hours, and various modes of communication between patients and providers.
  • Payment – is value driven and reflective of case mix, enhanced technologies, quality improvements, and shared savings achieved by successful patient management.

In keeping with these principles, the medical home goal is to deliver coordinated care in a seamless and efficient manner, thereby improving quality and reducing cost.

MedPAC has defined accountable care organizations (ACOs) as a set of providers associated with a defined population of patients, accountable for the quality and cost of care delivered to that population.  While the population is larger and generally involves multiple practices, similar intent remains for the ACO to reduce cost through enhanced preventative care, disease management and improved quality through coordination of care.  In order to manage a population effectively, ACO governance models often include not only physician members, but also, hospital or physician hospital organization (PHO) and/or payer representatives.  Structured purposefully in opposition to fee-for -service (FFS), ACO members are rewarded for efficiency in the form of a shared bonus.  If, on the other hand, an ACO underestimates the cost of operation, the providers will earn less, thereby becoming ‘accountable’.

Healthcare is, and likely will continue to be, a local service.  Determining whether a PCMH or ACO is more appropriate will be fueled by the local physician community’s appetite for and ability to change. Establishing clear goals with corresponding metrics, creating a path for process improvement and developing appropriate financial incentives will be integral to driving this process forward.  In the absence of interoperable data, both organizational models must also find creative solutions for their health technology constraints.

As we prepare to learn the fate of the Patient Protection and Affordable Care Act, we find ourselves with the potential to transform care delivery through healthcare information technology, innovative team approaches and other new models of care.  With more than 500 physician practices in the United States, the metamorphosis to medical homes or ACOs will be a monumental undertaking.  Will it fundamentally improve care?  Listen in to find out more….

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