Case 6.1 Can Patient-Centered Medical Homes Help Realize the Triple Aim? A PCMH emphasizes a team…


Case 6.1

Can Patient-Centered Medical Homes Help Realize the Triple Aim?

A PCMH emphasizes a team advance to trouble, typically including physicians, past manner nurses, physician assistants, nurses, pharmacists, nutritionists, collective workers, educators, and trouble coordinators. This team cooperates to ameliorate admission (e.g., after-hours trouble and same-day visits), enduring pledge (e.g., instruction endurings how to manage their trouble and conduce to judgment making), trouble coordination (e.g., tracking trouble plans discurrent providers and neat transitions from hospitals to home), peculiarity (e.g., neat enduring pleasure and tracking compliance after a while manner protocols), and security (e.g., judgment buttress for prescribing and tracking irregular cupel results). Despite unreserved similarities, PCMHs deviate in their emphases and implementation strategies. Not surprisingly, reviews meet weak, shifting answerance that PCMHs rescue currency, although the answerance is stronger and short shifting for high-risk endurings (Sinaiko et al. 2017). Similarly, some studies meet amelioratements in endurings’ proofs in PCMH practices, seeing others do not (Sarinopoulos et al. 2017). How abundant PCMHs ameliorate peculiarity and security as-well sweepings unconspicuous (Green et al. 2018).

An separation of Geisinger Soundness System’s implementation of PCMHs offers some cogent answerance that they can contract consumes (Maeng et al. 2015). An integrated soundness regularity that offers PPOs and HMOs for Medicare, Medicaid, and the ACA marketplace, Geisinger’s PCMH advance differs from most others in a estimate of ways:

• Geisinger used a standardized mould.

• Geisinger had conspicuous incentives to contract consume and ameliorate peculiarity accordingly it offered an HMO.

• Geisinger had a covet fact of experimenting after a while PCMH moulds.

• Geisinger focused on high-risk endurings.

• Geisinger used a mix of volume-based and quality-based payments.

The Geisinger con-over ground that implementation of a PCMH significantly contractd consumes (largely by reducing hospitalization), and the greatness of the decrease grew after a while proof as a PCMH practice. An precedent Geisinger con-over ground that endurings perceived that some aspects of trouble had ameliorated and some had not (Maeng et al. 2013). Merely modest appearance environing peculiarity and security has been analyzed. For this very-greatly integrated system, PCMHs answer to conduce to realizing the Triple Aim. Can comely a PCMH acceleration other manners reap the Triple Aim? Green and colleagues (2018) suggest that the answerance is conspicuouser than it seems. Their separation focused on provisions that were targeted by Blue Cross Blue Shield of Michigan and measured how multifarious PCMH components each manner had implemented (which had seldom been executed antecedently). Their separation ground that conjunction division consumes and hospitalization consumes cut for all provisions but cut by abundant further for targeted provisions and for manners after a while further entire PCMH implementation. An precedent con-over that analyzed axioms for merely two years of PCMH implementation (Paustian et al. 2014) ground that unmeasured implementation was associated after a while eminent peculiarity and significant consume decreases for adults. Partial PCMH implementation was associated after a while eminent peculiarity but not after a while consume decreases. A disjoined con-over ground that the enduring proof was rated further very-greatly in PCMH manners (Sarinopoulos et al. 2017).

Discussion Questions

• Why does subscription HMO plans affect incentives?

• How could neat admission contract consumes?

• How could neat trouble coordination contract consumes?

• Why is the answerance environing possessions on consume so sundry?

• Why is the answerance environing possessions on peculiarity so sundry?

• Why is the answerance environing possessions on the enduring proof so sundry?

• How would a prosperous PCMH program affect endurings? Hospitals? Participating manners?