The Patient Protection and Affordable Care Act (ACA)
Patient-Centered Medical Home (PCMH)
Patient Protection and Affordable Care Act
What This Is
The PCMH model of care undertakes the delivery of health services through high-quality, cost-effective, and personalized care through coordination by a primary care provider (PCP). The PCP is responsible for leading the interdisciplinary team and encouraging cooperation and collaboration between the providers and the patient. The idea of the medical home originated with the American Academy of Pediatrics (AAP) in 1967 and is defined today by the AAP as "family-centered"; the goal is to ensure that the medical and non-medical needs of the patient are met. Other physician organizations have since developed their own medical home concepts, with the Medicare Payment and Advisory Committee (MedPAC) recommending a pilot Medicare project to study the value of medical home models in 2006.
The primary distinguishing characteristic of the PCMH is the focus on a single practice with multiple physicians, while its counterpart, the Accountable Care Organization, houses many practices within one organizing entity.
In 2011, the Centers for Medicare and Medicaid Services (CMS) released a request for applications for the Comprehensive Primary Care Initiative, which will help primary care practices deliver higher quality, better coordinated, and more patient-centered care. Demonstration projects will be under Medicare as well as state agencies.
The characteristics of the PCMH, as developed by the American Academy of Family Physicians (AAFP), AAP, American College of Physicians (ACP), and American Osteopathic Association (AOA) include
- personal physicians who have an ongoing relationship to provide first contact, continuous, and comprehensive care;
- a physician-directed medical practice where the personal physician leads a team that collectively takes responsibility for the care of the patient;
- whole-person orientation, with the personal physician arranging care with other qualified professionals, including care for all stages of life, acute care, chronic care, preventive services, and end-of-life care;
- integrated and/or coordinated care across all elements of the complex health care system and the patient's community—facilitated by registries, information technology, and health information exchanges—and delivered in a culturally and linguistically appropriate manner;
- evidence-based medicine, participation in quality improvement activities by patients and families, engagement in performance measurement and improvement by physicians, and use of information technology to support patient care and communication;
- enhanced access to care, such as open scheduling, expanded hours, and new options for communications between patients and providers;
- payment that appropriately reflects the value of patient-centered care management, supports the use of health information technology and enhanced communication, and allows for sharing savings from reduced hospitalizations and for additional payment for achieving measureable and continuous quality improvements;
- the delivery of preventative care to proactively assess the needs of patients.
What This Means for SLPs and Audiologists
Accountability, collaboration, and communication with the PCP become the responsibility of the specialist as the subject matter expert. As elements of the PCMH are found in other models of patient care, such as Accountable Care Organizations, the audiologist and speech-language pathologist will need to market their services to the PCMHs, including strategies to (a) access records (including electronic health records), (b) use reporting quality measures, and (c) establish regular communication with the PCP and other team members. Early Hearing Detection and Intervention programs have incorporated the PCMH in the Year 2007 Position Statement of the AAP's Joint Committee on Infant Hearing.
Implementation Time Line
Implementation is an ongoing process, with new initiatives and demonstrations projects periodically introduced by the Center for Medicare and Medicaid Innovation and private health plans.
ASHA will continue to monitor initiatives and demonstrations related to the PCMH model.