Three Ways to Approach the PCMH Process: An Expert’s Advice

If your facility or practice delivers primary care, you may be considering whether you should apply to be recognized as a Patient-Centered Medical Home (PCMH), a designation that can benefit your organization in many ways. We spoke with Deborah Johnson Ingram, Primary Care Development Corporation’s Senior Director leading the PCMH facilitation team, to get some insider perspective on the different approaches organizations may take as they move forward with getting PCMH recognition.

1. Top-down Initiative

If you are an administrator interested in moving your organization towards getting PCMH designation, you will need to get buy-in from your whole team, from physicians and nurses to front desk staff. People may see this as extra work that you are giving them, rather than a transition to a different way of doing things to benefit patients, clinicians, and the organization as a whole. Get everyone together to explain the benefits of going through this process. Without the willing participation of your employees, it will be difficult to complete the necessary steps to get approval.

2. Clinician-led Initiative

In many facilities, it will be a physician or nurse practitioner who first sees the value of applying for PCMH designation. If that practitioner is also an administrator, then he or she will still need to communicate the value of this method to other clinicians and staff. But if the administration makes the final decisions, a medical practitioner will need to communicate the benefits to different levels of the organization. For the administration, PCMH could mean higher reimbursements, better efficiency, and improved patient outcomes, which in turn improves the reputation of the practice. For other staff, the benefits of clearer systems, improved patient care, and the chance to help patients who are most at risk for adverse outcomes can be selling points. As a medical practitioner, you can center your argument on the benefit to the patient community and the organization as a whole, all from the perspective of providing the most comprehensive care for each patient who walks through the door.

3. Government Agency/Health Plan Initiatives

The federal government, health plans, and some state Medicaid administrations have taken the initiative to encourage more providers to become PCMH recognized by implementing programs to assist organizations in the application process and financial incentives to those who receive PCMH designation. The Health Resources and Services Administration (HRSA), the administration that oversees Federally Qualified Health Centers (FQHCs) and other public health authorities and even health insurers have a vested interest in the patient population having fewer ER visits, better overall health, and putting off major illnesses within the population for as long as possible. For insurers, it costs less to control diabetes, for example, than to deal with major complications that can arise. A patient-centered practice supports evidence based clinical monitoring and care management of chronic conditions like diabetes. The model helps providers and their care teams keep a good eye on the most at-risk patients, which is good for the bottom line of insurers, and for the mission of public health departments who are charged with improving whole population health.

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PCMHs can benefit those who need care the most. By tracking patients and providing the wrap-around services that will improve health outcomes within the population, having a PCMH located in an area that needs better health access can be transformative for the community. The PCMH care model delivers appropriate health care to patients and can benefit both large and small health care practices in rural or urban settings.