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What is the Value of a Patient Centered Medical Home?

By Zach Wachtl, MD

Going to the doctor can be very different these days, especially if you consider how it contrasts with experiences 50, 25, or even 10 years ago. Perhaps in the past, or in some places today, when you got sick you sat in a waiting room, had your vitals taken, waited in an exam room, then saw your doctor (who did not carry a computer with her!) who perhaps handed you an illegible handwritten prescription on a piece of paper at the end of the visit.

Contrast that with what may happen when you come to my office, which is a certified Patient Centered Medical Home (PCMH). Your appointment may happen after ‘normal business hours’ because we recognize it isn’t always possible to get out of work to come to the doctor. In addition to seeing me, your family physician, you are likely to see multiple other members of my care team. A nurse could meet with you to review your blood sugar log or adjust your blood thinner. A case manager may help you find resources for food, housing, or transportation, or to commend you on your efforts at stopping smoking. A behavioral health specialist will have a brief interaction with you to help you cope with chronic illness or an acute mental health issue. My computer system will alert me that you are due for a screening test or an immunization for which you (or I) weren’t even aware. Your appointment was possibly prompted by a different part of the computer system (programmed by our IT team) who recognized you were due for a checkup based on your particular health history. A clinical pharmacist would review your medications to minimize risk of interactions or help find a cheaper or more effective alternative based on your new insurance formulary. A referral coordinator may see if you are having difficulty scheduling your visit with a specialist we arranged during your last appointment, and a medical records specialist will work to retrieve records of that visit.

Why in the world would you want to see so many people, when you just wanted to see the doctor? In short, because we understand that improving and safeguarding your health is complex and challenging, but can be done better with a team approach. Complexity from insurance, formularies and networks is challenging for patients and providers to navigate. We now recognize that there is much more to health than health care. Societal and environmental factors such as poverty, transportation, discrimination and housing all strongly impact an individual’s health, to name only a few. The role that mental illness plays in affecting health is much more widely acknowledged. Preventative care has the potential to bolster health, but is often not on the top of people’s agendas. But the key is that all of these things, if addressed together, can lead to better health. Most studies show PCMH can lead to fewer ER visits, less hospitalizations, and less money spent altogether on health care. This primary care team, or PCMH, can keep you healthier!

But what is PCMH? It is term used to indicate that an office has some combination of factors that strive to address the whole system of health care, with the patient at the heart. Not every PCMH will offer the same things, but all strive to provide more comprehensive care and services than can typically be provided by a doctor acting alone. The sticking point in providing all of these services is that they cost more, and are only beginning to be reimbursed. Studies suggest that the additional cost of supporting the basic additional care provided by the PCMH team is between $4 and $16 PMPM, but also that there is a 2-4 times return on investment based on cost savings from decreased care expenditure elsewhere (for example, by preventing more expensive hospitalizations and ER visits). So essentially, yes, the PCMH model is more costly up front, but it saves you a great deal of money in the long run.

I am proud of the team I work with in my PCMH, and can’t imagine providing care in a setting that doesn’t offer this wraparound support. And I want the same type of team helping me navigate the health care system when I take off my “doctor hat,” put on my “patient hat” and go see my own family physician for my health care.