Advanced Medical Home: Model of Care Offers Hope for Ailing Healthcare System

Jack Ginsburg, M.P.E.

Michael S. Barr, M.D., M.B.A., FACP

By Michael S. Barr, M.D., M.B.A., FACP
and Jack Ginsburg, M.P.E.

The U.S. healthcare system is poorly prepared to meet the current, let alone the future, healthcare needs of an aging population. Healthcare costs are continuing to grow faster than the economy, and employers, government agencies and individuals are straining under the financial burden.

In this environment, physicians are pressured to see more patients in less time1 as they are inundated with administrative paperwork and regulatory requirements. In addition, they have the added pressure of staying current with an overload of information in a medical environment that is increasingly more technical and complicated, and they struggle to keep their practices afloat in the face of declining revenues and increasing costs.

Trusting, intimate relationships with patients have suffered as physicians and patients struggle with the financial and bureaucratic complexities of public and private insurance coverage issues, which can cause substantial stress within patient-physician relationships.2

Physicians also must stay current with ever-expanding medical knowledge and technology in accord with evolving medical standards of quality. To make matters worse, insufficient numbers of young physicians are entering careers in primary care, and increasing numbers of older physicians are dissatisfied with their careers and indicate that they will soon discontinue practice.

In too many instances, unnecessary or inappropriate healthcare services are provided because there is little coordination of patient care among providers or across sites of service.3

As a solution, the American College of Physicians (ACP) proposed the advanced medical home model which offers the potential to improve U.S. healthcare by focusing on strengthening and supporting the patient-physician relationship. Since the release of the policy paper in January 2006, the ACP, American Academy of Family Physicians, American Academy of Pediatricians and the American Osteopathic Association have adopted a set of joint principles based on each organization’s respective policy.

As a result, the term now used by all of these organizations is the “Patient-Centered Medical Home” or PCMH. This model involves a central resource – the PCMH – as the foundation with a competent team of healthcare providers led by a personal physician, typically a primary care doctor. The team would include a physician with training in complex, chronic care management and coordination, and the team encourages active involvement by informed patients.

Widespread implementation of this model could result in positive fundamental changes in the way that primary care and principal care are delivered and financed. It recommends:

• Provision of enhanced and convenient access to care not only through face-to-face visits, but also via telephone, email, and other modes of communication;
• Ongoing, coordinated medical care in partnership with patients and their families;
• Provision of feedback and guidance on the overall performance of physicians and their practices;
• Use of evidence-based guidelines and clinical decision support tools to guide decision making at the point of care based on patient-specific factors;
• Application of appropriate health information technology;
• A voluntary recognition process to identify primary care and specialty medical practices that provide patient-centered care based on the principles of the chronic care model; and
• Demonstration of the use of “best practices” to consistently and reliably meet the needs of patients while being accountable for the quality and value of care provided

The ACP introduced the term “advanced medical home” to distinguish these practices and called for consideration and testing of this model of care with four policy positions. To read the policy, visit www.acponline.org.

The ACP believes that the advanced medical home model – now referred to as the Patient-Centered Medical Home – applied in the context of a revised reimbursement system – could revitalize the patient-physician relationship; stimulate practice-level innovation; allow practices to invest in systems-based care and measurement of that care; and enhance coordination of care across all domains of the healthcare system.

The concept has garnered significant attention from consumers, employers, payers, disease management companies and other stakeholders who are now working together through the Patient-Centered Primary Care Collaborative (www.pcpcc.net) to foster the changes necessary – including legislation, demonstration projects, and reimbursement reform – to help implement and test the model.

In addition, the National Committee for Quality Assurance (NCQA) just released a new version of their Physician Practice Connections’ recognition program-tailored with guidance from the ACP, AAFP, AAP and AOA to help identify practices that deliver care based on the Patient-Centered Medical Home model.

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