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PCMH Model Soaring, Despite Funding Challenges

January 20, 2016

"Showing payers the ROI of the [patient-centered medical home] model will help them want to [support] it. Payers are realizing increasingly that it is a good investment on their part," says NCQA executive Paul Cotton.

Patient-centered medical homes are exploding in popularity as healthcare organizations look for new models of care to lower costs and improve quality and outcomes. 

Research from the National Committee for Quality Assurance finds that the number of PCMH incentive programs around the country has increased from 26 in 2009 to over 160 today, a growth of about 82%.

Paul Cotton

NCQA recently shared its findings on trends and challenges within the PCMH construct in a Google Hangout session.
A More Patient-centered Approach
PCMH models are appealing to providers that are trying to shift toward value and away from fee-for-service medicine because they place an emphasis on primary care services in order to reduce the overutilization of expensive healthcare resources, particularly by patients with chronic conditions, says Paul Cotton, NCQA's director, federal affairs.

Rural Rivals Team Up to Coordinate Care

"I think the patient-centered medical home model can really be the cornerstone of the transition from volume to value because it focuses on primary care and on what patients themselves most value. The traditional primary care model has been the patient waits in the waiting room, then sees the doctor for five or ten minutes. Patients didn't have a long-term relationship with the doctor and you were on your own to coordinate your care," he says.

"The PCMH makes sure you are looked after by a team of providers who know who you are and what you need. They know who your other providers are, and they have your back. They also have access to electronic health records that allow them to coordinate care in a more patient-centered way."

Better coordinated and more effective primary care helps health systems lower the overall cost of care while also improving the patient experience, Cotton adds.

"By providing patient-centered primary care, providers can do a much better job of caring for that individual. What we are seeing [from the data] is that because they have better primary care, patients are much less likely to get complications that require them to go to the emergency department or to have a hospital stay. This is reducing expenses because those are much more expensive than a visit to a primary care doctor. PCMH patients … also tend to be happier with their care, which is one part of the movement toward value," he says.


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