What is a Patient-Centered Medical Home?

The concept of a “Medical Home” has been around for a long time. The American Academy of Pediatrics (AAP) introduced the medical home in 1967 and later expanded upon the framework in conjunction with the American Academy of Family Physicians (AAFP), American College of Physicians (ACP), and American Osteopathic Association (AOA). The current definition of the Patient-Centered Medical Home (PCMH) is “an approach to providing comprehensive primary care for children, youth and adults. The PCMH is a health care setting that facilitates partnerships between individual patients, and their personal physicians, and when appropriate, the patient’s family.”

The Patient Centered Primary Care Collaborative is an oversight body that was established to “advance an effective and efficient health system built on a strong foundation of primary care”.

Does the patient-centered medical home have an equivalent in Canada? Is there something that can be learned from the U.S. experience?

Many of the principles established for the PCMH are similar to those associated with primary care reform programs implemented in the Canadian provinces including care coordination, preventive health, and chronic disease management, supported by a strong foundation of information technology in order to provide team-based care.

Each of the founding organizations has developed approaches and strategies that were appropriate for their membership.

• AAFP – TransforMED Patient Centered Model
• ACP – Patient Centered Medical Home. View a short video developed by the ACP and the Medical Home Builder developed to support practices through this change
• AAP – National Center for Medical Home Implementation

The National Center for Quality Assurance (NCQA) has recognized over 4,700 practices that have become medical homes

What is the incentive for becoming a Patient-Centered Medical Home?

• Opportunity for U.S. primary care physicians to participate in grant funded projects such as primary research and development of educational materials.
• Payment reform driving change and the need to implement population health management with reportable metrics. Many U.S. physicians have 10–15% of their income potentially at stake through payment reform programs in conjunction with penalties.
• Accountable Care Organizations (ACOs) — Payment and care delivery models that tie provider reimbursements to quality metrics in conjunction with reductions in total costs of care for patient populations.
• A competitive marketplace for healthcare delivery and services.
• Consumer-driven programs that are driving demand by patients for healthcare services.

There is a great deal of innovation taking place with consumer health, driving change through demand for new models of care delivery.

Bottom line: it is not possible to make these changes without EMRs and information technology, further driving the demand (and need) for sophisticated systems that enable these new models of care.

Comparing the differences between primary care reform in Canada and the United States, my impression is the following:

• In Canada, there is a slow, methodical, provincially-driven process to encourage technology adoption by providing funding and incentives to physicians and hospitals or health systems. The focus is more on what technology can deliver — the top-down approach.
• In the United States, the process of change is partially top-down; however, there is much greater consumer involvement and systems change driven by quality measurement.

Each has their strengths and weaknesses. However, I do believe that Canada can learn from the U.S. experience, particularly in terms of creating models of care that encourage safety and improve quality in a measureable way.

Should Canada take more of a bottom-up approach towards primary care and health system transformation? Add your thoughts by clicking on the “Comments” link below.