Patient Centered Medical Home (PCMH)
The purpose of investing in PCMH is to advance the large and growing body of evidence demonstrating that coordinated care delivered by primary care physicians, supported with information systems, and appropriate reimbursement incentives can improve the quality and efficiency of care provided to patients. This can be especially effective for patients with chronic illness(es).
At a Glance
The Patient Centered Medical Home (PCMH) is a model that emphasizes a comprehensive team approach to patient care. The PCMH will broaden access to primary care while enhancing care coordination. There are multiple PCMH practice levels. Clinicians practicing in the highest level medical home will:
- Take personal responsibility and accountability for the ongoing care of patients
- Be accessible to their patients on short notice for expanded hours and open scheduling
- Be able to conduct consultations through email and telephone
- Utilize the latest health information technology and evidence-based medical approaches, as well as maintain updated electronic personal health records
- Conduct regular check-ups with patients to identify looming health crises, and initiate treatment/prevention measures before costly, last-minute emergency procedures are required
- Advise patients on preventative care based on environmental and genetic risk factors they face
- Help patients make healthy lifestyle decisions
- Coordinate care, when needed, making sure procedures are relevant, necessary and performed efficiently[i]
Click on the following for more information:
- Support for Access and Care Coordination Payment Demonstrations
- Increased Fee-for-Service (FFS) Payment for Primary Care
- Support for Preventive Care
- Coverage and Service Expansion
- Health Center Payment Protections and Improvements
- Workforce Development
- Additional Resources
The Center for Medicare and Medicaid Services (CMS) will administer a number of demonstration projects promoting quality primary care. These include medical home demonstrations administered through the new CMS Center for Innovation, as well as changes in the health care law supporting PCMH concepts.
The ACA increases the Medicaid and Medicare payment rate by 10% to primary care practitioners for primary care services, effective FY 2011-2016 (Section 5501). Providers who work within a PCMH will be rewarded for high-quality care based on standards that they help develop, and on solid medical evidence. Medicare will pay bonuses to qualified primary care doctors and general surgeons, particularly those who practice in underserved areas.
The ACA improves access to preventive services in Medicaid and Medicare including:
- Any clinical preventive service recommended with a grade A or B by the U.S. Preventive Services Task Force (USPSTF)
- Adult immunizations recommended by the Advisory Committee on Immunization Practices (ACIP)
- Incentives for chronic disease prevention for Medicaid beneficiaries
For more information on how the ACA expands coverage for preventive care and service go to Preventive Care and Screenings on this site.
Medicaid will be expanded to all citizens under age 65 with incomes up to 133% of the federal poverty level (FPL) in FY 2014 (Section 2001). This change will result in coverage for approximately 16 million Americans who were previously uninsured. In California, Medicaid is called Medi-Cal. For more information on how the ACA expands of Medi-Cal coverage and service go to Medi-Cal Eligibility for Low Income Adults on this site.
Private insurers that offer plans through the new Health Benefit Exchanges must contract with health centers and cannot pay less than the Medicaid Prospective Payment System (PPS) rate. For more information about California’s Health Benefit Exchange, go to Health Benefit Exchange on this site.
Title IV of the ACA reauthorizes and expands workforce education and training programs under title VII and VIII of the Public Health Service Act. The purpose is to improve access and the delivery of health care services for all individuals, particularly low income, underserved, uninsured, minority, underserved and rural populations by:
- Gathering and assessing comprehensive data in order for the health care workforce to meet the health care needs of individuals, including research on the supply, demand, distribution, diversity, and skills needs of the health care workforce
- Increasing the supply of a qualified health care workforce to improve access to and the delivery of health care services for all individuals
- Enhancing health care workforce education and training to improve access to and the delivery of health care services for all individuals
- Providing support to the existing health care workforce to improve access to and the delivery of health care services for all individuals.[ii]
[i] Patient Centered Primary Care Collaborative, (2011, March, 10) Patient Centered Medical Home, http://www.pcpcc.net/patient-centered-medical-home.
[ii] WikiSource, (2011, March, 10) Patient Protection and Affordable Care Act/Title V, http://en.wikisource.org/wiki/Patient_Protection_and_Affordable_Care_Act/Title_V.