The patient-centered medical home (PCMH) has existed as a concept since it was first introduced by the American Academy of Pediatrics in 1967. It’s built on the foundation of the four Cs of primary care: first contact, comprehensive care, continuous care, and coordinated care. It adds on top of that three additional components: enhanced access, quality and safety, and payment reform.
We believe the concepts behind the PCMH are still relevant today, especially as more and more payers acknowledge that an increased investment in primary care is needed to drive positive outcomes of the populations they serve.
In this post, we’ll take a look at the seven essential aspects of a PCMH and explore how the advanced primary care (APC) model builds on them.
1. First contact
The fundamental idea behind first contact is that the primary care setting would be the first place that patients seek medical care. In this setting, patients have no ambiguity about where to go when they have health issues; the answer is always their primary care provider.
In the last few years, this approach has eroded as more and more people have used urgent care (or even speciality care) as their first point of contact. In the APC model, we return to this core principle by making a care center staffed by a dedicated care team the center of each member’s medical care. They establish care with a provider and always use that provider as the first point of contact.
2. Comprehensive care
As the quality of our healthcare system has continued to erode, primary care providers have gone from someone who provides the majority of care to simply being a production-oriented provider that serves as a gateway for prescriptions and referrals to costly specialist care.
The APC model challenges this normal and shifts care back into the primary care setting. Members receive 80-90% of the care that they need within the primary care setting. This results not only in better care for patients but also reduces the total cost of care because it drives down utilization of unnecessary specialty care.
3. Continuous care
A primary care provider that has to see 20-30 patients per day is forced to use a disease-focused approach to care rather than a patient-focused approach because they do not have adequate time to learn about individual patients and provide continuous care. Continuous care, on the other hand, emphasizes getting to know the patient as a person and developing an in-depth understanding of the multiple health issues they have. Over time, this enables the provider to help the patient make positive steps in their health.
Within the APC model, we achieve these positive steps in a number of ways:
Our patients spend extended time with providers, making it possible to build a relationship that focuses more than just on symptoms.
Each patient has a personalized care plan that all members of the care team reference.
We use an empathetic listening approach that acknowledges that the path to health doesn’t come through a prescription or a treatment, but rather through behavior change. To aid in the behavior change process, health coaches are integrated into all of our care teams.
4. Coordinated care
In the PCMH, care received outside of the primary care setting should be coordinated. In APC, the care team coordinates specialty care, including follow-up and integration into the member’s care plan back at the care center. This type of coordination prevents gaps in communication and treatment. This approach is especially beneficial to Medicare Advantage populations who are often managing multiple chronic conditions.
5. Enhanced access
Enhanced access focuses on removing barriers to care since receiving more care in the primary care setting is key to improving health outcomes. APC does this by creating convenient clinics, allowing for same-day patient scheduling, increasing time with providers, and removing the costs typically associated with a primary care visit so that members are empowered to see their provider as much as is necessary. Our entire model is built on the concept that increased utilization of primary care is the primary lever to improve health outcomes.
6. Quality & safety
In a traditional PCMH, quality and safety refers to providing care that meets the specific needs of the patient and establishing effective processes and controls to ensure that patients stay safe throughout their entire experience. In the APC model, payers have more control over the quality of care and the safety of their patients because they can work directly with the partner providing the care to ensure that the right safeguards are in place. This type of control isn’t possible when members are using various health systems and providers to receive care.
7. Payment reform
The final foundation of PCMH is payment reform. There are certainly many nuances to this specific topic, but the bottom line is that for primary care to achieve it’s necessary outcomes, it cannot be reliant on a financial model built on reimbursements for specific procedures. APC is a value-based model that aligns financial incentives between payers and providers around improving health outcomes, not any of the specific activities related to patient care.
As you can see, APC embraces the core principles of the PCMH and pushes them a step further, allowing payers to immediately improve the quality of their primary care, increase the health outcomes for the populations they serve, and control the total cost of care.