Traditionally, healthcare payments have been made on a fee-for-service basis. With recent trends in the healthcare world, many individuals are considering other models which provide a broad range of services while keeping the costs down. The two most popular models are PCMH and ACO. Both models provide options for coordinating medical care among many specialists and providers while paying a minimum fee for necessary treatments.
PCMH stands for the Patient-Centered Medical Home model, and was proposed in 2007 by the American Academy of Pediatrics, American Academy of Family Physicians, American Osteopathic Association, and American College of Physicians. PCMH is referred to in the Affordable Care Act as a viable method of improving health and medical care through coordination with qualified health professionals.
The goal of the PCMH is to coordinate health care for a patient, prevent possible medical situations from arising, and provide increased quality and safety of medical care by approved practitioners. All health care in this model is headed by a primary physician with whom the patient has a long-term medical relationship. The primary physician is responsible to provide continuous care and is designated as the primary contact for the patient. This physician refers the patient to other qualified professionals in the event that additional medical expertise is needed, and all selected providers collectively accept responsibility for the patient's care. Under the PCMH plan, service providers are sometimes given bonuses for improvements in primary care services for each medical home patient, which provides an additional incentive to offer quality care.
A medical home ensures that the patient is able to receive necessary care from any medical provider. By coordinating efforts, an individual can be given health care from a broad spectrum of specialists and hospitals. Home health agencies and nursing homes are included in the model, with the primary physician heading the individual's health plan.
The focus of a medical home is on evidence and outcomes. Evidence-based medicine assures the quality of the care. The planning process also considers clinical decision-support tools and measures proven performance of methods and procedures. This guarantees safety and quality, all while allowing the patients and their families, if appropriate, to be active participants in the-decision making process.
Patients who participate in PCMH are given increased access to medical care. Individuals seeking care are provided with additional scheduling options as well as expanded business hours. In addition, payments for those enrolled in PCMH are more comprehensive in order to cover the broad range of services provided.
The PCMH aims to improve health outcomes, focusing on results rather than volume. This model concentrates on individual needs by involving the patient, family, and primary physician in the health plan and by utilizing information technology, patient registries, and other professional such as nutritionists and healthcare coordinators.
The second model, The Accountable Care Organization (ACO), is comprised of many medical homes. Some refer to the ACO as a medical neighborhood, due to the multiple primary care practitioners who work together. According to The Urban Institute, an Accountable Care Organization is "a local health care organization and a related set of providers (at a minimum, primary care physicians, specialists, and hospitals) that can be held accountable for the cost and quality of care delivered to a defined patient population." ACOs emphasize accountability and provide monetary incentives to health care providers throughout the individual's care.
The ACO is accountable for the cost and quality of care that the individual receives. This includes the primary care physician and all other health providers who are used. To keep the expenses down, ACOs must include approved specialists and hospitals who agree to keep the costs to a minimum while improving health outcomes during the continuum of an individual's medical care. The goal of the ACO and emr vaccine system is to share the savings as well as the responsibility.
Being referred to as a medical neighborhood, ACOs are typically larger than a medical home or a physician's office. In accordance with the size, the ACO is able to better manage care for a larger population of people and to operate on a larger budget. This allows the ACO to track results to determine quality of care being given as well as manage costs.
Both the Patient Centered Medical Home and and Accountable Care Organization models are focused on improving the quality of the care while coordinating with qualified practitioners and medical providers. Each model encourages the use of electronic health records and patient registries. Continuous quality improvement is monitored to provide the best care.
The PCMH model has some drawbacks that are not within the control of the primary care provider. This model does not always offer monetary incentives for providers to collaborate and work together for improved health. In addition, most primary care practices don't receive compensation for a decreased number of hospital and emergency room visits. These factors may arguably provide little incentive for preventative care.
The ACO model focuses on a coordinated and patient-centered care system. Many professionals hope that the ACO model will eliminate the challenges encountered with the PCMH system. ACO models are "meant to allow providers to break away from the tyranny of the 15-minute visit, instill a renewed sense of collegiality, and return to the type of medicine that patients and families want. For patients, coordinated care means more ‘quality time’ with their physician and care team (a patient’s advocate in an increasingly complex medical system) and more collaboration in leading a healthy life," according to The Centers for Medicare and Medicaid Services (CMS). In order to verify that these goals are being accomplished, CMS requires ACOs to provide proof of quality and patient satisfaction, as well as numerically tracking chronic disease prevention and management.
ACOs require strong leadership and coordination to be successful, and can in turn provide infrastructure and benefits to the PCMH model. ACOs focus on delivering positive outcomes and improved quality while at the same time reducing medical costs. The ACO and PCMH models are complementary models that are able to improve health care services and keep costs down.