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The Difference Between Patient-Centered Medical Homes & Medicaid Health Homes (In Plain English)

User Category: PolicyOn: April 29, 2013

In healthcare, it’s common to hear buzzwords thrown around. In the past we have given you a handy guide for navigating the tricky acronyms elder care professionals and caregivers frequently come across.  Given the complexity of innovation in the healthcare field, it’s sometimes tough to keep up the development of new care delivery models. Recently two community-based care models have garnered a great deal of attention: the patient-centered medical home (PCMH) model and the concept of Medicaid health homes.While, patient-centered medical homes and health homes share some similarities, there are key differences in how each model enhances care for those with chronic conditions and supports aging in place. We break those down for you here:The Patient-Centered Medical Home (PCMH) Model Proposed in 2007 by the American Academy of Family Physicians (AAFP), American Academy of Pediatrics (ACP), American College of Physicians (AAP), and American Osteopathic Association (AOA), the patient-centered medical home model aims to provide comprehensive, coordinated, and continuous care for all populations from children to seniors. It requires a team-based, physician-led approach that seeks to enhance the role of primary care and organize care around the patient. According to the Patient-Centered Primary Care Collaborative, clinicians practicing within the medical home model:

  • Assume responsibility for the ongoing care of patients and coordinate care over multiple settings
  • Are more accessible to patients by providing expanded hours, easier scheduling, and remote consultations by phone and email
  • Utilize electronic personal health records
  • Conduct regular checkups and encourage preventative care
Medicaid Health HomesAs of early 2011, the Patient Protection and Affordable Care Act (ACA) health reform law established “health homes” as a Medicaid option to provide services specifically for beneficiaries with chronic conditions. Health homes are designed to a person-centered, integrated care model that coordinates medical care, behavioral health services, as well as community and social supports.What Medicaid patients are eligible for participation in a health home?
  • Those with two chronic conditions
  • Those with one chronic condition and risk of a second
  • Those with one “serious and persistent” mental health condition
According to the ACA, health homes must provide the following services:
  • Comprehensive care management
  • Care coordination and health promotion
  • Transitional inpatient to outpatient care
  • Individual and family support
  • Referrals to community and social support services
  • Services linked through health information technology
In many states the health home model builds upon the medical home model, expanding the linkages and breadth of services to support the needs of those with chronic illnesses. The goal of the Medicaid home health model is to improve clinical outcomes and overall healthcare quality for persons with long-term conditions, as well as reduce per-capita healthcare expenditures by delivering more effective, coordinated care. Unlike the PCMH model, States have flexibility to determine eligible health home providers. The provider may be a designated professional such as health clinic or home health agency or a team of health professionals which may include mental health workers, dieticians, nurses, and pharmacists.What has your experience been with community-based care delivery models such as PCMH and Medicaid Health Homes? 

Comment

  • […] Patient-Centered Medical Home (PCMH) Model is a new approach which seeks to enhance care coordination and community-based […]

  • Jonathan Smolowe says:

    And so we get to the root of the issue: the provider ISN’T king! PCMH fosters the notion that the provider still rules. MHH at least opens the door (and the possibilities) to a patient in control of her/his own destiny.

    The notion behind the Affordable Care Act is that we can achieve the Triple Aim: (1) Improve outcomes and improve population health, (2) Decrease the per capita cost of healthcare, and (3) Increase participation by all stakeholders. In the “Provider Rules” world, my belief is that the patient is not at the core and is not viewed as an equal partner in the process – and thus the Triple Aim under these terms is far more difficult to achieve.

    In a truly patient-centered model, patients are provided a combination of synchronous and asynchronous tools to take more control over their own health and thus the outcomes. Communication in this approach is critical: between providers, between patient and providers, between patient and the patients’ extended families, and, oh yes, let’s not forget the payers! When all stakeholders have the appropriate tools and are empowered in the process, the Triple Aim becomes a far more realistic achievement.

    Doug makes a very powerful point: Behavioral Health MUST be considered. And a strong bridge between Behavioral Health and Physical Health must (must must must) exist.

    Both PCMH and MHH are steps in the right direction. Just don’t forget the position and the power of the patient!

  • Excellent and important discussion. These distinctions are too easily mis-understood and conflated into a mishmash that fails to fully achieve the objectives of either model.

    To foster discussion and perhaps even a little debate, I’d like to offer an observation. From a practical perspective, perhaps the two most important distinctions between PCMH and Medicaid Health Homes are:

    1) The increased focus on behavioral health under the MHH model. While BH is also within the scope of the PMCH model, in practice it puts the burden on the primary care physician to coordinate and manage BH as well as medical health. Alternatively, the MHH model increases the focus on BH thereby allowing either BH or primary care to serve as the center of care coordination. This is a significant difference that offers tremendous potential for improved health outcomes and lower cost.

    2) The PCMH model is rooted in how the primary care physician manages the extended care team on behalf of the patient. There isn’t too much direct emphasis on patient engagement or patient self-management. It is primarily a provider-centric model. In contrast, MHH at least implies a greater focus on patient engagement and patient self-management. This shift in emphasis is very important because it addresses the issue of initial and persistent use of healthcare services in the Medicaid population, which has been shown to directly correlate with achieving the Triple Aim.

    So, both models serve an important purpose. PCMH is a necessary step in the right direction, while MHH may offer additional long term value particularly for the Medicaid population because of its greater focus on BH and Patient Engagement.

    Looking forward to your comments.

    • Hi Doug, thank you for your extremely thoughtful and insightful comments. You bring up an important point about behavioral health. So often a the physical affects the mental and vice versa, so that it is impossible to treat only physical aliments in isolation. I’d be interested to hear other readers’ thoughts about the difference between the models in regards to the role of the primary care physician.

  • Nanette J. Davis says:

    I would like to further explore these models. Thanks much. Nanette Davis

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