Patient Centered Medical Home SLP
Health is a very important factor in any individual’s life; however, some people cannot afford better medication due to the lack of funds and hospitals and difficulties in places they live. Medical services cannot reach them due to poor infrastructure and illiteracy. This leads to the high level of mortality within the population because of improper care. However, a group of doctor-patient NGOs in partnership with the government have come up with Community Health Centers that offer primary care to patients. They exercise willingness in helping the sick without asking funds or any other special document for them to be treated. They also work in collaboration with hospitals and other well-wishers to achieve excellence in healthcare delivery. Therefore, Community Health Centers do not work to gain profit; they rather work together with the patient in order to improve their health. Despite not conforming to the principles embraced by for-profit health care institutions, the success realized by the Maryland Patient Centered Medical Home (PCMH) is a clear demonstration that Community Health Centers have the ability to improve the health status of the community.
The Maryland PCMH model took into account various factors. The greatest achievement of the model is the integration it creates between the patients’ ongoing treatment and the patients’ family. The model further supports management of chronic illnesses through the support system with specialized coordinators. During every patient’s visit, the reconciliation of medical records is done to ensure the records stay updated and facilitate consistent monitoring of the patient’s health. Another prominent feature of the model is the enhanced and expanded accessibility of primary healthcare services. The services are available on a 24-hour basis, and patients can access the services or consult healthcare workers through their telephone. The healthcare workers are always available to respond to the patients’ calls. Similarly, there is a same day appointment service. Through this service, patients can call and book an appointment when they have urgent cases that require immediate care. Finally, the Maryland PCMH model also supports continuous communication between patients and healthcare workers such as physicians through the use of e-mails.
Maryland PCMH embodies a model of primary healthcare delivery that aims at improving the relationships between clinicians and patients. It aims at introducing a long-term healing relationship and doing away with episodic care. PCMH is based on principles developed by AAP, AAFP, ACP, and AOA. In PMCH model, each patient is assigned a personal trained physician who monitors and provides first contact of how the patient is faring, offering continuous and comprehensive care. The principles also provide for physicians directed medical practice, which entails the use of medical teams who take responsibility for ongoing care of patients (AAFP, AAP, ACP, & AOA, 2007). There is also the service of whole person orientation. The service tasks the personal physician with the responsibility for providing all patients’ health care needs on every stage of life, including acute care, chronic care, preventive services, and end-of-life care (AAFP, AAP, ACP, & AOA, 2007).
The Maryland pilot study started in 2011, focusing on testing the model of multi-specialty and primary practices. In total, it targeted 52 practices (Maryland Health Care Commission, n. d.). Health Care Centers target all members of the community. Similarly, Maryland PCMH pilot program targeted all people that needed healthcare services in the state. Community Health Centers offer comprehensive health care, so they treat the whole person, offering primary medical, dental, mental, and prescription medical services. In addition, Community Health Centers offer other wellness services such as pediatric, nutrition, exercise among others (Maryland Health Care Commission, n. d.). The pilot program sought to provide similar services in order to prove holistic care to all patients. This program introduced the use of technology in the healthcare center to help in managing patient and disease information. With the use of technology such as electronic health records, the healthcare center’s staff and providers can easily communicate and share important information on the patients that they are serving. Such ease of information exchange and documentation facilitates the entire team taking care of a patient to coordinate their activities (Maryland Health Care Commission, n. d.).
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The pilot program was supported by many payers, since Maryland implemented a Muli-Payer Patient Centered Medical Home Program. They included the full healthcare insurance providers (CareFirst, CIGNA, Coventry, Aetna, and UnitedHealthcare), Federal Employees Health Benefit Plan, TRICARE, Maryland State Employees Health Benefit Plan, plans provided by private employers, and Uniformed Service members’ healthcare services (Maryland Health Care Commission, n. d.).
A number of providers also participated; they include John Hopkins Community Physicians, Department of Family Medicine at the University of Marylyn, Community Health Resources Commission, Maryland Health Care Commission, and Department of Health and Mental Hygiene (Maryland Health Care Commission, n. d.).
The participating providers in Patient Centered Medical Home are usually reimbursed through various methods. In the Maryland Multi-Payer PCMH, the reimbursement methods include fee-for-service payments with new service codes such as e-visits. Second, it can be done through care management fees. Third, the reimbursement can be made through bonus payments for meeting certain criteria, like National Committee for Quality Assurance (NCQA) certification as well as quality or performance incentives. There is also an option of the fixed transformation payment (FTP), which is a per-patient per-month fee that should be paid semi-annually according to the provisions of NCQA. One more kind of payment can be made through shared savings eligibility. The eligibility is based on healthcare costs savings earned through improved patient outcomes and better patient care. A formula was chosen to calculate the shared saving values. It took into account all patient costs, including the percentage of costs that occur outside the primary healthcare system (94%) (Maryland Health Care Commission, n. d.). This system, however, does not seem to please the providers. A three-part payment methodology is recommended by Patient Centered Primary Care Collaborative. The methodology that comprises components for rendered services, care management, and performance, may be the best compromise, since it entails fee-for-service, per-patient-per-month, and pay-for-performance ways of payment. These attributes make the Patient Centered Primary Care Collaborative methodology the easiest and best way of reimbursing providers.
The ability of PCMH to improve people’s livelihoods and health was the main reason of the idea development. Implementing the PCMH pilot program in Maryland resulted in several benefits. A function flow chart was created for Patient Centered Primary Care Collaborative(See Figure 1 below). The chart is an effective explanation of the benefits of patient centered primary care and the strategies of providing care. The chart clearly presents five components of PCMH model: commitment to quality and safety, comprehensiveness, focusing on the patient, coordination, and accessibility. The chart provides features of the elements and strategies used by the different parties involved in the model. The pilot project reported improvement in provision of healthcare service to the community. The rate of healthcare information among patients increased, making them more aware of their health habit and encouraging them to improve their health habits (Maryland Learning Collaborative, n. d.). Availability of the service also encouraged more patients to seek health care service and information from healthcare providers such as physicians and clinicians. The greatest achievement of the project was increasing the collaboration amongst stakeholders in the healthcare industry or primary healthcare provision. There was improved collaboration between healthcare staff and patients, healthcare institutions and government healthcare bodies.
Figure 1 (Patient-Centered Primary Care Collaborative, 2013)
In conclusion, the program was successful, and continued implementation of the process will result in more positive outcomes. Continued collaboration and commitment of the payers will ensure that the program stays sustainable. The Maryland PCMH pilot program incorporated technology and improved documentation and information exchange. Patient Centered Medical Home renders not-for-profit services to its patients; hence, the services are affordable to everyone. The services are reimbursed through a variety of methods designed to encourage service provides to deliver quality service to patients. They offer nutrition, pediatric, and exercises services to the recovering patients. Community Health Centers work ensuring people live a healthy life. Subsequently, the initiatives have improved the living standards of the people around the centers who embrace this program.