The Patient-Centered Medical Home Solution to the Cost-Quality Conundrum

EXECUTIVE SUMMARY The U.S. healthcare system has been plagued by rising costs while achieving relatively poor-quality outcomes, and the situation continues to worsen. One solution is the patient-centered medical home (PCMH) model of primary care. This model focuses on care coordination and development of long-term physician-patient relationships that are expected to lead to better quality care and higher rates of patient satisfaction than have previously been achieved. Although the PCMH features a number of core principles, significant differences are seen across models. Three of the most prevalent models are those offered by the American Academy of Family Physicians, National Demonstration Project, and National Committee for Quality Assurance (NCQA). After analysis, the NCQA approach emerged as the recommended model due to its specificity and comprehensiveness. Research suggests that the PCMH, and specifically the NCQA model, can achieve both increases in quality and reductions in cost. However, this finding is tempered by the challenges inherent in implementation. INTRODUCTION The problem of increasing costs accompanied by merely average quality care in the U.S. healthcare system is well documented. As of 2012, according to the Kaiser Family Foundation (KFF, 2012), healthcare expenditures in the United States comprised 17.9% of gross domestic product, equating to $8,402 spent on healthcare per person. The same report projects that by 2020, healthcare expenditures will be nearly one fifth of the U.S. economy, at 19.8%. Furthermore, not only is the U.S. healthcare system the most expensive in the world but it is 48% more costly per capita than the system ranked second in healthcare expenditures, that of Switzerland (KFF, 2012). However, the extensive spending on the U.S. healthcare system does not yield outstanding quality. Instead, by most measures, healthcare in the United States is at best average compared to other countries. The World Health Organization (WHO, 2011) ranks the U.S. system 37th in the world, behind some countries considered to be less developed, such as Cyprus and Costa Rica. Moreover, while the United States is the world leader in medical research, it lags the other Organisation for Economic Co-operation and Development (OECD, 2011) nations in terms of life expectancy and infant mortality. These findings have given rise over the past 40 years to many solutions to improve quality of care in the United States while lowering costs. The remainder of this essay analyzes a key element emerging from health reform--the patient-centered medical home (PCMH)--as a potential solution to this conundrum. BACKGROUND The concept of the medical home was first introduced into the practice of pediatrics by the American Academy of Pediatrics in the 1960s. At that time, the term referred to a primary care practice that partnered with families in caring for children. As the model grew, it began to take on many of the principles now associated with the PCMH, such as coordinated and comprehensive care. In 1978, WHO met to discuss the medical home, specifically endorsing primary care's role in carrying the medical home forward. WHO believed that primary care was integral to maintaining an individual's health and identified specific functions that primary care providers should perform toward that end. These included the following (Robert Graham Center, 2007): * Address the prevailing health needs of the community * Educate the public about health issues * Provide preventive services The broad scope of primary care makes pediatrics ideal for accomplishing these tasks and participating in the medical home. But while WHO detailed the benefits of primary care in the late 1970s, it was not until the 1990s that the principles of primary care and the PCMH were linked (Robert Graham Center, 2007). At that time, the Institute of Medicine (IOM, 1996) mentioned the medical home in conjunction with supporting the tenets of primary care, and in its 2001 report Crossing the Quality Chasm, IOM declared patient-centered care to be a main goal of the U. …