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Disciussing the Patient Centered Medical Home Concept with Your Aging Parents

July 29, 2013

In an effort to gain control of exorbitant health care spending the think tanks and number crunchers are always looking for ways to cut costs. Over the past few years there has been a trend building to establish the concept of the Patient Centered Medical Home.

This is not necessarily a new idea, but rather a return to a previous way of providing health care. Actually it’s a simpler way as well which you will see as we work out way through this post.

Your grandparents or great-grandparents rarely had the choice of more than one doctor in town unless they lived in the big city. Even then most patients saw one doctor for all their health care needs. There weren’t many specialists. If a person did see a specialist it was because their family doctor couldn’t handle what was needed and sent them to the specialist based on a personal relationship.

A family doctor treated everyone in the family, delivered babies, tended the dying and records were kept in one office. Under this model there weren’t health oversight agencies monitoring quality or insurance companies paying f or services rendered. A patient saw the doctor, paid for services rendered out of his own pocket, and was either satisfied or not with the care given.

Since the middle of the 20th Century patients have been exposed to more specialists and some patients no longer have one regular doctor they see.  Services may be paid for by the individual patient, a private insurance policy, state aid, Medicare, and even secondary or tertiary insurance policies (including Workman’s Compensation or other liability insurance policies).

In addition, the patient may be seen by more than one doctor for a single illness or injury and there may be very little communication between those doctors about the course of treatment and expected outcomes. It’s gotten so bad that a doctor treating a patient for a hip fracture may not even be aware of the patient’s previous history of mini-strokes or advanced diabetes. This can lead to incomplete treatment or even dangerous medication interactions. Patient preferences aren’t usually explored under that type of care and yet the costs of treatment continue to skyrocket.

Enter the concept of the Patient Centered Medical Home:

  • The patient chooses a Primary Care Provider
  • The Primary Care Provider is a member of a Primary Care Team which may include mid-level practitioners (Physician Assistants and Nurse Practitioners known as PAs and NPS).
  • The Primary Care Team may also include nurses or medical assistants who work as support staff with the doctors and mid-levels.
  • There is usually at least one Case Manager and a Referral Coordinator as part of the Primary Care Team.
  • Admissions clerks, schedulers, medical records clerks, billing staff, and quality assurance auditors are also supportive members for the team.

What are the benefits of the Patient Centered Medical Home?

  • The patient is at the center of all care.
    1. The patient’s opinion is solicited before treatment goals are established
    2. The patient’s motivational level to participate in treatment is assessed and integrated into the plan of care
    3. The patient is an active participant in developing the care plan and the goals and at what pace the goals will be worked on.
    4. The patient’s level of understanding of the diagnosis, treatment plan, and desired outcomes is reassessed frequently making communication a key factor in all treatment.
    5. The patient is encouraged to be an active participant in their care through self management based on their perceived abilities and willingness.
    6. The patient has access to care and advice 24/7 by a trusted and familiar team
    7. If the patient requires hospitalization the PCMH team is involved and aware of what is taking place during that hospitalization.
    8. When the patient is released from the hospital the PCMH provides follow up and any additional outpatient care.
  • All patient needs are coordinated through the Patient Centered Medical Home (PCMH).
  • This means that ALL referrals to specialists, outside labs, imaging centers, mental health counseling, home health agencies, hospice, and community resources can be coordinated through the PCMH.
  • Records (or copies) from all referrals and services are gathered and kept in one place so that the Primary Care Team is aware of all treatments and can coordinate accordingly.
  • Care is no longer fractured.
  • Preventive services are monitored based on evidence based guidelines and patients are reminded when they are due for immunizations (flu and pneumonia shots, tetanus boosters etc.), mammograms and pap smears, colonoscopies, certain blood tests based on individual patient diagnoses, and other screening tests as needed.
  • One of the biggest benefits of the PCMH is that services are coordinated and followed based on individual patient needs. This cuts costs by reducing duplicate tests, unneeded referrals and miscommunication between providers.
  • Another huge benefit of the PCMH is that patients know who their providers are and a level of trust is developed with the entire team so that if there is a changeover in personnel there are still people on the team who are familiar. This increased level of trust leads to better communication for all parties, less stress for patients, and a greater understanding for patients that they are in control of their health care and the outcomes.

What you can do to facilitate the Patient Centered Medical Home process for your parents:

  • Encourage them to put together a list of the questions they would like to ask their doctor.
  • Assist them in getting to know the members of the PCMH team (if this is available at the clinic or doctor’s office they use).
  • Make a list of all medications your parents are taking (name of med, dose, who prescribed it, the purpose in taking the medication, what time they are supposed to take the medication, and how often). Be sure the lists includes all over the counter medications such as Ibuprofen or Tylenol and any vitamins and/or herbal supplements they are taking as well. During their next medical visit have your parents take the list and all the medicine bottles and supplements with them to the doctor appointment for review.
  • Make a list of all medication, food, and environmental allergies your parents may have and what type of reaction exposure to these allergens elicits.
  • The biggest thing you can do to assist your parents in getting the most from the PCMH is encourage them to become partners with their health care providers. Explain the benefits of open two-way communication. Assist them in building trust with the PCMH team. Fianlly, be supportive of all efforts your parents make to be more involved in their health care.

What are your thoughts on the idea of Patient Centered Medical Homes and the team involved? Have you had any experience with this? Feel free to share your ideas and experiences in the comments.

Thank you for reading my blog. I hope you find this information useful. I am here to provide you with information and ways to increase the dialogue between you and your aging parents.

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