Doctors and Lawyers: The PCMH as a model for a CCLP
by Ryan McClead- 3 -
I believe the use of the word "home" in this case muddles the meaning, but it'sintended to be less off-putting and more inviting to patients than the words "MedicalPractice". The PCMH model, is an attempt to re-engineer the practice of medicinefrom the unholy mess that naturally evolved between the interactions of hospitals,doctors, government agencies, and insurance companies in the late 20th century, intoan efficient 21st century medical care machine, with patient well-being as its primaryfocus.There are four areas that the PCMH addresses:
Team-based Primary Care
is about doctors sharing the responsibility forpatient primary care with "nurses, care coordinators, patient educators, clinicalpharmacists, social workers, behavioral health specialists, and other team members."
Historically, doctors have been very proprietary with patient access, refusing to allowother doctors, or especially non-doctors, to treat their patients. In a PCMH, data andrecords are openly shared (within appropriate regulatory guidelines) and primarypatient care is a group effort.
Active Patient Involvement
is making patients active participants in theirmedical care, rather than passive recipients of treatment. This requires the help of the larger team to educate and work with the patient to arrive at the best course of action.
Evidence-based Practice Improvement
means applying the scientific methodto common medical procedures, which sounds obvious, but has not always been thecase. Doctors, often believe that the way they have always done it is the best way todo something. Practice improvement challenges the status-quo by testing andconfirming best practices with actual data rather than anecdotal evidence.And finally,
is restructuring the way that doctors andinsurance companies are paid to align the financial incentives in the medical industrywith the needs of the patient, instead of the needs of the medical practitioners orinsurance companies.This sounds great, but the value is not in defining the areas that need reform,but in actually creating a clear path to get there. There is a regulatory component tothe PCMH that is administered by a non-profit organization called theNationalCommittee for Quality Assurance (NCQA).NCQA has established clear guidelines for any medical practice to qualify as aPCMH. They've broken the guidelines down into 6 distinct Standards which eachinclude between 2 and 7 individually scored elements and a single Must-Pass Element.The Must-Pass Elements are: 1) Access During Office Hours; 2) Use Data for PopulationManagement; 3) Care Management; 4) Support Self-Care Process; 5) Referral Trackingand Follow-Up; and 6) Implement Continuous Quality Improvement. These 6 Must-Pass Elements are things that any competent medical practice should already bedoing.