1. Component 1: Introduction to Health Care and Public Health in the U.S. 1.9: Unit 9: The evolution and reform of healthcare in the US 1.9d: The Patient Centered Medical Home

2. History of The Medical Home Concept 1967 -- The American Academy of Pediatrics (AAP) introduced the medical home concept 2002 -- the AAP expanded the medical home concept to include specific characteristics of patient care: –Accessible –Continuous –Comprehensive –Family-centered –Coordinated –Compassionate –Culturally effective Component 1/Unit 9d2 Health IT Workforce Curriculum Version 1.0/Fall 2010

3. History of The Medical Home Concept (continued) The American Academy of Family Physicians (AAFP) and the American College of Physicians (ACP) have developed their own models for improving patient care –2004 – AAFP “medical home” –2006 – ACP “advanced medical home” Component 1/Unit 9d3 Health IT Workforce Curriculum Version 1.0/Fall 2010

4. The Patient Centered Medical Home (PCMH) 2007 -- Joint Principles of the Patient Centered Medical Home delineated by: –American Academy of Family Physicians (AAFP) –American Academy of Pediatrics (AAP) –American College of Physicians (ACP) –American Osteopathic Association (AOA) The PCMH is an approach to providing comprehensive primary care The PCMH is a health care setting that facilitates partnerships Component 1/Unit 9d4 Health IT Workforce Curriculum Version 1.0/Fall 2010

5. PCMH Characteristics: Personal Physician, Directed Medical Practice Personal physician - each patient has an ongoing relationship with a personal physician Physician directed medical practice – the personal physician leads a team of individuals at the practice level –The team takes collective responsibility for patient care Component 1/Unit 9d5 Health IT Workforce Curriculum Version 1.0/Fall 2010

6. PCMH Characteristics: Whole Person Orientation Whole person orientation – the personal physician is responsible for providing for all the patient’s health care needs Care is provided in all stages of life Care is provided in multiple settings –Acute care –Chronic care –Preventive services –End of life care Component 1/Unit 9d6 Health IT Workforce Curriculum Version 1.0/Fall 2010

7. PCMH Characteristics: Coordination Of Care Care is coordinated and/or integrated across all elements of the health care system and the patient’s community Care is facilitated by technology Clinicians provide care that is culturally and linguistically appropriate Component 1/Unit 9d7 Health IT Workforce Curriculum Version 1.0/Fall 2010

8. PCMH Characteristics: Quality And Safety Quality and safety measures: Patients are encouraged to achieve patient-centered outcomes Clinicians use evidence based medicine and clinical decision support tools to guide their decision making Component 1/Unit 9d8 Health IT Workforce Curriculum Version 1.0/Fall 2010

9. PCMH Characteristics: Quality And Safety (continued) Other quality and safety measures: PCMH model uses information technology to support patient care Practices agree to undergo voluntary recognition process Component 1/Unit 9d9 Health IT Workforce Curriculum Version 1.0/Fall 2010

10. PCMH Characteristics: Quality And Safety (continued) Other quality and safety measures: Physicians participate in continuous quality improvement and performance measurement Patients participate in decision-making Patients and families participate in quality improvement activities Component 1/Unit 9d10 Health IT Workforce Curriculum Version 1.0/Fall 2010

11. PCMH Characteristics: Enhanced Access To Care Enhanced access to care facilitated by: –Open-access scheduling –Expanded hours –New options for communication Secure messaging and email Use of personal health records Component 1/Unit 9d11 Health IT Workforce Curriculum Version 1.0/Fall 2010

12. PCMH Characteristics: Payment Payment appropriately recognizes the added value of a patient-centered medical home Reflects the value of patient-centered care management work Pays for face-to-face visits as well as services associated with coordination of care Component 1/Unit 9d12 Health IT Workforce Curriculum Version 1.0/Fall 2010

13. PCMH Characteristics: Payment (continued) Additionally, the PCMH payment model: –Recognizes case mix differences in the practice patient population –Allows for additional payments when quality improvements are achieved –Covers enhanced patient communication access to clinicians –Supports adoption and use of health information technology Component 1/Unit 9d13 Health IT Workforce Curriculum Version 1.0/Fall 2010