California ACP Patient-Centered Medical Home Subcommittee

June 3, 2009

Introduction:
The definition and requirements for a PCMH are in flux and there is much debate about these issues. There are four key aspects to a patient-centered medical home that are widely reviewed and are important to include if primary care is to be the central focus of health care reform:

  1. Patient-centered primary care for all patients. This includes: 1) access to high quality care (including disease prevention and an emphasis on healthy lifestyles); 2) continuity; 3) coordination; 4) involvement of family and friends; 5) patient physical comfort; 6) respect; 7) information and education; and 8) emotional support. This is the foundation of the PCMH from which the functions of the health care team, the information system, selected quality monitors and financial reimbursement should be developed to support.
  2. Chronic Care Management for patients with complex conditions. Patients with one or more chronic conditions do best with an integrated care model that emphasizes excellent care, maximization of quality of life, patient self-management and coordination of care and support. Such chronic care programs have been shown to improve quality of care at reduced total health care cost.
  3. Information Management Systems. This is the technical aspect of the PCMH and one that the NCQA certification delineates. The NCQA definition of PCMH is widely criticized as not including relevant indicators for patient-centered care or chronic care management.
  4. Continuous process improvement and practice redesign are core aspects of a PCMH and require a well-functioning team of health care professionals, with excellent leadership skills, knowledge of quality improvement methods, communication skills and expertise in conflict resolution.

Value:
Primary care is central to improving health care quality, access and cost. Reforms are needed in the practice environment and reimbursement mechanisms to transform primary care to best serve the health care needs of Californians and to attract trainees into the profession.

Goals:
We aim to develop a Demonstration Project to provide resources and coordination to the smaller primary care practices in California that are committed to becoming Patient Centered Medical Homes, either as a single practice or as a collaboration of groups in a region. To that end, the steering committee will:

  • Coordinate existing resources or develop new ones:
  • Tools and materials (where possible)
  • Links to California foundations, professional societies, policy makers, health care funders, clinical practice leaders and consumers
  • Funding mechanisms
  • Guidance on performance measurement and evaluation

Page updated: 09/15/09

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