Glossary

The Future of Health Care: PCMH

One way to fix the problem of spiraling health care costs is to try to change the health care system. It isn’t easy. It means completely changing the way everyone does business. But we can’t keep doing what we’re doing because things will just keep getting worse. Hawaii already got a good start in making changes, but more needs to be done.

Big picture: The problem is the way the health care system pays for care. It’s called a fee-for-service business model, and it hasn’t changed much since the start of modern health care. Under this model, doctors, hospitals, and other providers are paid for every service they provide – every visit, every test, and procedure they do – whether or not these things improve our health. It’s based on quantity instead of quality.

It can lead to unneeded tests, screenings, and other expensive care that adds to health care costs each year, without making people healthier and, in some cases, making them even less healthy. And it often results in doctors not having enough time to give the care they want to give. According to a recent study, a primary care provider (PCP) would need more than 22 hours a day to finish all of the work expected of them, whether giving care or doing paperwork.

To try to fix this system, insurers, hospitals, doctors, the government, and professional and trade groups are working together to change the way health care works. The major part of that effort is moving from the fee-for-service model to a new patient-centered medical home model. It’s kind of a weird name, but if you think about what it’s trying to do, it makes sense.

A patient-centered medical home, or PCMH, is not a physical building. It’s a way to care for patients so that you feel “at home” with your care. PCMH changes the emphasis from quantity to quality, helping everyone be healthier and reduce the need for costly care.

It’s been proven that when people have a long history with their PCP, they are healthier and have lower health care costs. Kind of makes sense, right? The better your doctor knows you and is aware of factors that might affect your health, such as stress, the more likely it is that diseases can be prevented or caught early, when treating them costs less and before they cause big problems. And as a bonus, when you have a good relationship with your doctor, you’re usually better informed about your health and lead a healthier lifestyle. It’s easier for a doctor who knows you well to effectively nag you!

A key goal of PCMH is to improve the relationship between you and your doctor. A big part of that is giving doctors the time they need to give that familiar level of care. So PCMH helps PCPs change their practices. They are put in charge of teams of providers customized to meet your unique health needs – so if you have a chronic condition, health care “extenders” with expertise in treating your condition could be on your team. The team may also include staff members and health and wellness organizations that offer education, screenings, and other support.

PCMH

The PCMH system supports these teams with information and a new way to pay for care. Using the latest technology, like electronic health records, makes the team more efficient and improves communication. New detailed reports of patient histories help the team identify patients who need screenings, follow-up visits, and immunizations. That means your doctor and your whole team will have more information to better help you. It will also increase the coordination between different providers on your team. And instead of getting paid for every service they provide, providers are rewarded for making sure you get the right care you need when you need it. It’s about paying for quality.

But it’s not all up to the team. As the name implies, PCMH puts you at the center of your care, encouraging you to take an active role in improving and maintaining your health. After all, a team of doctors can only make recommendations. You are the only one who can make yourself exercise, eat right, get your recommended screenings and tests, take your medications as prescribed, and do what you need to do to manage any chronic conditions you have.

PCMH is a big part of health care reform efforts across the country, and Hawaii’s health care industry is already on the way to making it a reality for folks across the state, including you.

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