Imagine a diabetes patient going to her primary-care physician with health concerns related to her condition. Instead of getting an initial assessment and being referred out, an interdisciplinary team immediately starts working on her case, involving her throughout the process. As part of that team, a psychologist assesses her level of depression, knowing that it often goes hand in hand with diabetes. The psychologist might also devise behavioral strategies to control her blood glucose levels.
That dream scenario would be commonplace in a patient-centered medical home, also referred to as a "health home." First conceived in 1967 by pediatricians as a way to coordinate care for children with developmental disabilities, the concept is regaining steam as a way to make primary care more robust, comprehensive and cost-effective. Versions of the concept — which is a central part of the 2010 health-care reform law — are already being adopted at the Mayo Clinic, the Department of Veterans Affairs and in pilot projects nationwide.
There is increasing evidence in the literature that care provided in a patient and family-centered medical home leads to improved outcomes. The medical home concept refers to the provision of comprehensive primary care services that facilitates communication and shared decision-making between the patient, his/her primary care providers, other providers, and the patient's family.
The PCMH concept was included as a program in national health care reform legislation with components similar to joint principles developed by the American Academy of Family Physicians (AAFP), American Academy of Pediatrics (AAP), American College of Physicians (ACP), and the American Osteopathic Association (AOA):
Personal physician – Each patient has an ongoing relationship with a personal physician trained to provide first contact, continuous, and comprehensive care.
Physician directed medical practice – The personal physician leads a team of individuals at the practice level who collectively take responsibility for the ongoing care of patients.
Whole person orientation – The personal physician is responsible for providing for all the patient's health care needs or taking responsibility for appropriately arranging care with other professionals.
Care is coordinated and/or integrated across all elements of the complex health care system (e.g., subspecialty care, hospitals, home health agencies, nursing homes) and the patient's community.
Quality and safety are hallmarks of the medical home, supporting the attainment of optimal, patient-centered outcomes.
Enhanced access to care is available through systems such as open scheduling, expanded hours, and new options for communication between patients, their personal physician, and practice staff.
Payment appropriately recognizes the added value provided to patients who have a PCMH.