The patient-centered medical home (PCMH) has become a widely-used frameworks for a healthcare organization’s transition to value-based accountable care. With its focus on quality, care coordination, preventative services, and chronic disease management, the PCMH highlights the goals of the Triple Aim while integrating health IT into population health management and more personalized individual care.
But how effective are the efforts of payers and providers as they adopt the principles of the PCMH to cut costs and improve care? There is mounting evidence showing that the industry may be on the right track with the model’s mix of data analytics, population management, EHR adoption, and pro-active transformation.
One of the primary features of the patient-centered medical home is the development of a patient care team that works together to provide coordinated services for each patient as he or she moves along the care continuum. The primary care provider (PCP) actsas a centralized hub for the patient, managing his or her need for specialty consults, synthesizing data that comes back from these specialists, and working with the patient’s hospital setting to maintain awareness of emergency events, admissions, and discharges.