As the drumbeat of health care reform becomes ever louder, so does the hysteria surrounding system change. Having come of age clinically during the heyday of “managed care”, I find the criticism that “advanced primary care” is just another name for an HMO particularly disingenuous.

In order that some of you might spread the word that this is care far removed from “HumanaCare”, I have taken the Principles from the Patient Centered Primary Care website and noted which were not included in traditional managed care:

Principles of “Advanced Primary Care”  Bold italics  indicates not a part of HMO model

Personal physician—each patient has an ongoing relationship with a personal physician trained to provide first contact, continuous and comprehensive care.

Physician directed medical practice— the personal physician leads a team of individuals at the practice level who collectively take responsibility for the ongoing care of patients.

Whole person orientation—the personal physician is responsible for providing for all the patient’s health care needs or taking responsibility for appropriately arranging care with other qualified professionals. This includes care for all stages of life; acute care; chronic care; preventive services; and end of life care.

Care is coordinated and/or integrated across all elements of the complex health care system (e.g., subspecialty care, hospitals, home health agencies, nursing homes) and the patient’s community (e.g., family, public and private community-based services). Care is facilitated by registries, information technology, health information exchange and other means to assure that patients get the indicated care when and where they need and want it in a culturally and linguistically appropriate manner.

Quality and safety are hallmarks of the medical home:

  • Practices advocate for their patients to support the attainment of optimal, patient-centered outcomes that are defined by a care planning process driven by a compassionate, robust partnership between physicians, patients, and the patient’s family.
  • Evidence-based medicine and clinical decision support tools guide decision making.
  • Physicians in the practice accept accountability for continuous quality improvement through voluntary engagement in performance measurement and improvement.
  • Patients actively participate in decision-making and feedback is sought to ensure patients’ expectations are being met.
  • Information technology is utilized appropriately to support optimal patient care, performance measurement  patient education, and enhanced communication
  • Practices go through a voluntary recognition process by an appropriate non-governmental entity to demonstrate that they have the capabilities to provide patient centered services consistent with the medical home model.
  • Patients and families participate in quality improvement activities at the practice level.

Enhanced access to care is available through systems such as open scheduling, expanded hours and new options for communication between patients, their personal physician, and practice staff.

Payment appropriately recognizes the added value provided to patients who have a Patient-Centered Medical Home. The payment structure should be based on the following framework:

  • It should reflect the value of physician and non-physician staff patient-centered care management work that falls outside of the face-to-face visit.
  • It should pay for services associated with coordination of care both within a given practice and between consultants, ancillary providers, and community resources.
  • It should support adoption and use of health information technology for quality improvement.
  • It should support provision of enhanced communication access such as secure e-mail and telephone consultation.
  • It should recognize the value of physician work associated with remote monitoring of clinical data using technology.
  • It should allow for separate fee-for-service payments for face-to-face visits. (Payments for care management services that fall outside of the face-to-face visit, as described above, should not result in a reduction in the payments for face-to-face visits).
  • It should recognize case mix differences in the patient population being treated within the practice.
  • It should allow physicians to share in savings from reduced hospitalizations associated with physician guided care management in the office setting.
  • It should allow for additional payments for achieving measurable and continuous quality improvements.
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