In July of 2010 MRHS became the first organization in the state of Nebraska to achieve a Level III certifcation as a Patient-Centered Medical Home by National Council on Quality Assurance. Please read the information below that details the elements of a Patient-Centered Medical Home. As a patient at one of our clinics you will enjoy all the benefits of our Medical Home.
Medical home, also known as Patient-Centered Medical Home (PCMH), is defined as “an approach to providing comprehensive primary care… that facilitates partnerships between individual patients, and their personal physicians, and when appropriate, the patient’s family”. The provision of medical homes may allow better access to health care, increase satisfaction with care, and improve health. This goes beyond the traditional model of primary care in the US, changing the physician’s role from the passive, “I’ll treat anything that comes in the door” to a process of seeking out patients with risk factors and addressing the issues before a problem arises.
Among the recommendations of four national organizations (AAFP, ACP, AOA, AAP) in primary care was that every American should have a “personal medical home” through which to receive his or her acute, chronic, andpreventive services. The services should be “accessible, accountable, comprehensive, integrated, patient-centered, safe, scientifically valid, and satisfying to both patients and their physicians.”
The principles are:
- Personal physician: “each patient has an ongoing relationship with a personal physician trained to provide first contact, continuous and comprehensive care.” All of our physicians make personal connections with their patients.
- 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.” Even though some of the care provided is by nurses and midlevel providers, the care is all directed by the personal physician. When the doctor has to do everything, he becomes the bottleneck to providing care. The Medical Home frees up the physician’s time to make the more complex decisions while the other members of the MRHS care team work to the limit of their license to attend to the myriads of issues involved in modern day health care. Everyone becomes part of the care, which is more than simply supporting the doctor.
- 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.” We do as much as we can for the patients, and, recognizing our own limitations, arrange for others to do what we cannot. Decisions have to include the specific circumstances of the patient, from their economic resources to emotional support of the family, and the patient’s personal preferences and specific sensitivities and lifestyle choices.
- Care is coordinated and/or integrated, for example across specialists, hospitals, home health agencies, and nursing homes. Our care partners have signed an agreement with us to provide this care. They have committed themselves to supporting the patient as we have.
- Quality and safety are assured by a care planning process, evidence-based medicine, clinical decision-support tools, performance measurement, active participation of patients in decision-making, information technology, a voluntary recognition process, quality improvement activities, and other measures. The base of this is in the ability to abstract information from our electronic medical record. Pure patient care data, stripped of all identifiers, is uploaded to a central computer that adds our information to that of about 7 million patients nationwide. We then receive reports of how we are doing, compared to our own previous performance and against national averages. We can process this ourselves in order to identify the patients we have that are not where they need to be from a health standpoint, We can then contact these patients to arrange for the necessary care. This Quality Assurance extends to patient satisfaction surveys as well as regular “workflow” meetings held so that all levels of our organization contributed to ways we can improve our processes of care. Our computer system gives us warnings of possible drug to drug interactions, and notifies our care providers of care deficiencies. Regular audits of controlled substance utilization help us identify patients at risk of addiction and substance abuse. Each medical record has the picture of the patient to avoid confusing records. We have the capacity to work with third party carriers in the production of quality indicators if they also wish to partner with us.
- Enhanced access to care is available (e.g., via “open scheduling, expanded hours and new options for communication”). There is access to communication with use by phone, mail, and our patient portal. We are working on a system of email notification of lab values in the hope of expanding access to Email in general.
Some suggest that the medical home mimics the managed care “gatekeeper” models historically employed byHMOs; however, there are important distinctions between our care coordination in the medical home and the “gatekeeper” model. In the medical home, the patient has open access to see whatever physician they choose. Unless dictated by their insurance company, no referral or permission is required. The personal physician of choice, who has comprehensive knowledge of the patient’s medical conditions, facilitates and provides information to subspecialists involved in the care of the patient. The gatekeeper model placed more financial risk on the physicians resulting in rewards for less care. The medical home puts emphasis on medical management rewarding quality patient-centered care.
Since starting the Medical Home, we have seen dramatic improvement in the health of our diabetics. With the success we have had over the last 6 months in Diabetes, we are moving next to cardiovascular diseases and hyperlipidemia. We have also seen improving rates of mammography, vaccination and colonoscopy screening. While some patients are reluctant to participate in our more aggressive screening and preventative care, all acknowledge the benefit is to their health.
MRHS has always been a terrific place to go if you were sick. We’d like it to be a terrific place to go to NOT be sick.