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Defining the Patient-Centered Medical Home

Defining the Patient-Centered Medical Home

About a decade ago, family physician Ramona Seidel left her position as family medicine director at a large multi-specialty practice to explore a different style of practicing. "I wanted to be able to spend more time with my patients, and I wanted to have increased transparency,” she says, noting that she also wanted to help her patients “get through the maze of care coordination” and help them understand her role as “more than just an urgent-care kind of provider."

To focus on those goals, Seidel opened up a solo practice in Arnold, Md., in 2003. Though the model of care she embraced didn't yet have a widely recognized name, today it's known as the Patient-Centered Medical Home (PCMH) — and it's picking up traction across the country.

In fact, the medical-home model is quickly becoming the "new normal" at pediatric and primary-care practices, says Susanne Madden, president and CEO of The Verden Group consulting firm.

"This is the way care is evolving," says Madden. "To really not tackle the Patient-Centered Medical Home, I think, is to sort of leave yourself on the sidelines while the rest of the industry moves by."

But getting in the game is not easy, says medical practice consultant Ewa Matuszewski, cofounder and CEO of Medical Network One, a Rochester, Mich.-based physicians' services organization. "One of our favorite comments is that to transform into a PCMH is like eating an elephant," says Matuszewski. "You bite into it one bite at a time." Here's a closer look at the requirements for transitioning to a medical home, and some tips for determining whether it's the right move for your practice.

Finding solid ground

The most widely recognized medical-home program is set forth by the National Committee for Quality Assurance (NCQA), a nonprofit organization dedicated to improving healthcare quality. To achieve NCQA recognition (as Seidel has done) practices must demonstrate the ability to provide six elements of care. These elements include improving care access, coordination, and quality. For more information on the six elements, see sidebar: "PCMH Recognition Criteria."

While it's not easy to become a medical home — Madden estimates it can take anywhere from four to 12 months for a typical fee-for-service practice to transition to the style of practicing laid out by the NCQA — it's worth serious consideration. "Frankly, I think what will happen is the payers will start paring payments based on who has Patient-Centered Medical Home recognition status and who does not, and what that means is that if you haven't achieved that recognition, you're likely to be on the chopping block for rate cuts pretty soon," says Madden, who is also cofounder of Patient Centered Solutions, which helps practices achieve NCQA recognition. "It's not just about taking advantage of incentives, but making sure that you are really solidifying your position in the marketplace going forward," she says.

Prerequisites

The good news is that any primary-care practice has the ability to successfully transition to the medical home, though practice size is linked to different transition challenges and opportunities, says family physician Terry McGeeney, president and CEO of TransforMED, a nonprofit subsidiary of the American Academy of Family Physicians that specializes in helping practices transition to medical homes. Smaller practices may find it easier to get staff on board, for instance, while larger practices may have better access to helpful resources, such as EHRs. Regardless of practice size, strong leadership, effective communication, and a team mentality are all a necessity to successfully transition, says McGeeney.

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