PCMH — Patient Centered Maximized Healthcare
As more and more stakeholders in the health care and policy worlds commit to transforming how care is delivered to our patients and how care is paid for, the concepts of Patient Centered Medical Home (PCMH) have provided the framework and opportunity for truly meaningful change. The persistent elephant in the room, however, is that many still do not like the term "medical home". It often does not resonate with providers who want to be more than "homes" for their patients and patients often include it in the continuum of parent’s home, nursing home and funeral home.
The PCMH term developed a strong presence in legislative language and on the public stage at about the same time that many were recognizing that the concepts were right but the name may not be. We continue to struggle with acceptance of the "medical home" label today. We have often talked about how the ultimate goal is to leverage the concepts of PCMH to create patient centered, high performing practices in a patient centered high performing system. We then need new payment methodologies that reward high performance not volume. In other words, doing things that produce maximal outcomes for the betterment of our patients and not just creating volume that the current payment system rewards.
It may be the time to consider "PCMH" in a different light — "Patient Centered Maximized Healthcare". A practice ultimately strives to be an entity that provides maximized health care. Physicians wake up every morning wanting to maximize the health of their patients. Payers want to pay differently for care that is maximal. Policymakers understand that if the US Healthcare System is going to survive that the country needs PCMH but rather than "medical homes for all" it may be "maximized health care for all".
"Maximized Healthcare" implies value. Value in today’s world is often described in terms of outcomes/cost ratios. Primary Care is perfectly positioned to provide that value. Many of the recent pilots have demonstrated that when primary care practices transform around the principles of PCMH, quality goes up and overall health care costs go down. The important next step in the evolution of the PCMH concept may be to transition from "medical homes" to "patient centered maximized health care delivery systems" and expect appropriate physician payment for such. We have said for a long time that it is about the "concepts" of PCMH and not the name. "PCMH" may come to represent much more than primary care practices, but the "maximized health care system" we currently call the medical neighborhood.
On another note, I would like to congratulate the TransforMED staff at the one year anniversary of the Delta-Exchange. The Delta-Exchange has exceeded all expectations as the first national social networking platform for practices actively engaged in Practice Transformation. Our goal was to create a nationwide, on-line learning community for those involved in actually taking care of patients. We have done that. The most recent addition to the Delta-Exchange of webinars and resources around best practices for chronic disease is off to a great start. As we continue to move toward our goal of "Patient Centered Maximized Healthcare", the Delta-Exchange has become a valuable resource – particularly for the small practices – to engage and transform.