Patient Centered Medical Home

Introduction

The need for home healthcare continually helps some minority and poor/marginalized individuals in achieving the health care that they need. The fact that unreasonable payments and reimbursement of funds have been noted in the home healthcare programs may not impede individuals from ultimately having the intended home health care (Winkler, 2015). As the population of America grows old, there will be more pressure on the social security systems. Due to these changes, it will be necessary to ensure a comprehensive homecare plan for the elderly persons. The trend in the reduction of individuals who pay taxes against those who benefit from the health care services places home care at the top of the list. Home health care is considered as an alternative and cost-effective method of ensuring that the patients receive care at home. The paper analyses the difference between Patient Centered Medical Home and Health Maintenance Organization. The paper aims at identifying the most effective way of providing quality and efficient home-based health care services to the sick, disabled, and aged people in the community.

Patient Centered Medical Home

In history, health care services were delivered in people’s homes where the doctors and nurses traveled to visit the sick individuals. In the advent of health care facility development, things have changed, and the patients can now be taken care of within the health care facilities away from their homes (Heyworth et al., 2014). In the past, doctors used to see their patients in very small offices or clinics. The clinics could not offer the doctors ample environment for delivering health care services to the patients; thus, there was need to extend visits to patients’ homes. Most communities have relied upon the home health care for long. Nevertheless, it later changed slowly into facility care.

As Wang et al. (2014) postulate, the concept of the medical home was developed around 40 years ago, aiming to provide an accessible, coordinated, continuous, and comprehensive patient-centered care. The PCMH model provides a framework for care organizing at the both the practice and the societal level. Here, all the patients would have a home where they are able to receive much of their medical care as well as additional coordinated care if required. Healthcare provision at home increasingly becomes an important issue. As Harris (2010) notes, sick people, the elderly, and people who suffer from various physical disabilities can now receive health care services in their homes without necessarily having to visit health care facilities. Health care services that can be provided to these people at their homes may include treatment of the sick, nursing of the elderly people, personal assistance to the disabled, and so on (Heyworth et al., 2014). However, many of these people suffer helplessly in their homes.

According to Prieto (2008), home-based health care continually evolves as the result of the changing needs of patients or clients and their families. This is different from the past when home-based health care programs only focused on the sick individuals in families. A patient-centered medical home integrates patients as active participants in their own health and well-being. A physician leads the medical team that coordinates all aspects of preventive care and handles acute and chronic needs of the patients using the best available evidence as well the appropriate technologies (Wang et al., 2014).

The PCMH has been meant to provide environment that will offer comfort and convenience to the patients as well as optimal health care within their communities. The following features are available at a PCMH. There is integrated and comprehensive primary team care. There are clinical information systems to support decision-making and patient registry. At the PCMH, there is ready access to care. There is also engagement of patients in care and decision-making process. Patient-centered care is provided with an emphasis on dignity and respect. Patient feedback is routed to providers. Information on the efficiency and quality of care is publicly available (Bleser et al., 2014).

This model of health care delivery as been considered as a pathway to excellent health care, reclaiming health professionals’ role as advocates for patients as well as their families while encouraging team-based care. It also channels educational opportunities and it may attract health professionals to primary care (Tavangaran, n.d).

The benefits that are given to individuals in home care include intermittent services, skilled nursing care, physiotherapy, aid in speech as well as language for the individuals and emotional and respite care. The physicians and the healthcare providers must be in face-to-face contact with the patient and must be able to review the patient periodically (Wang et al., 2014). On the other hand, individuals who require home health care services are often free to choose the service provider of choice. Home healthcare has Prospective Payment Service that determines the rate and level, at which health care providers are paid. Home health care is necessary for the reassurance of the patients’ wellbeing; thus, it is necessary to consider payments for the services.

Health Maintenance Organization

Managed Care is the system that has been employed by the United States to provide quality health care to its citizens at a lower cost. This has been done through special organizations called the Managed Care Organization (MCOs). This system has been established to ensure that all citizens are accessible to health care and that cost should not be a hindrance to the good health. As Tavangaran (n.d.) states, “Managed care comprises of Health Maintenance Organization (HMO), Independent Practice Association (IPA), Preferred Provider Organization (PPO), Point of Service (POS), and Private Fee-For-Service (PFFS).”

The term health maintenance organization was coined in the early 1970s as strategy of winning the Nixon administration support. In a health maintenance organization, one pays ahead for medical care and receives most of it at one given location. HMOs have been spreading as the result of the government backing. The health maintenance organizations have appeared to be the possible answer to the cost of health care that has been on the increase (Shi & Singh, 2012). The organizations have been remarkable in their impacts on the delivery of health care since their inception.

Generally, an HMO requires one to choose a primary care provider who can coordinate one’s care. Before one sees the doctor, one ought to be referred to them by their primary care provider (PCP). This type of coordination has been preferred by many people as it takes the guesswork out of looking for specialist and making sure that they are involved in a health insurance network (Berry et al., 2013). In an HMO, care does not have to be pre-authorized via the insurance company before any treatment can commence. Thus, it prevents delays in treatment and expedites the necessary tests and procedures. The cost of health care becomes a challenge for many healthcare systems. Those who manage the economics of healthcare are haunted by the dilemma, on which services to scale down and through which criteria. The HMO provides for adoption of a Medicare system where the government provides for its entire retired employee with health insurances, hence covering all the citizens and attaining its universal tag (Berry et al., 2013). The first impact is that health care is made affordable to all. It is enhanced by the Affordable Care Act that requires employers to insure their employees (Luft, 2011). HMOs settle the health of individuals who are part of their network. The physicians employed for care are also part of the network. The risk is bestowed on an individual, employer, or an insurance firm. Payments are done monthly, and referrals are officiated by PCP. PPOs encompass risk sharing to the downside or upside (Bleser et al., 2014). The patient pays after the services are delivered at a discounted rate. The health provider can be a member of a team or can be self-employed. All referrals are maintained within the network. POSs uphold a policy that the cost is partially shared upside or downside (Wang et al., 2014). The fee is also paid after the services have been disseminated but at a subsidized rate. The health care provider can be a team member or self employed.

Why Health IT, Workforce Development, and Payment Reform are Critical to the Success of the Patient Centered Medical Home

With the rising cost of health care worldwide, newer delivery models appear that will include telemedicine (Hoyt & Yoshihashi, 2014). In the case of the USA where Medicare will not reimburse for readmission for certain diseases, new strategies are needed to curb this. Therefore, this is where technology comes in. In today’s world, efficiency, speed, and convenience are fundamental parameters in delivering and accessing health care services. The majority of people have indicated the desire to have access to health care services that are less costly and effective. A virtual physician’s visit is one of the health care service delivery approaches that have proved to meet all the above requirements (Harris, 2010). Virtual health care visits employ the use of electronic communication to deliver health care services to patients at any place. It uses the current technology such as video chatting, mobile calling, and live chats to deliver health care services to patients without necessarily paying physical visits to clinical or health care centers.

This technology has attracted most of the insurance companies due to its efficiency and reliability. Health care organizations have embraced the technology and it takes the market by storm (Bleser et al., 2014). Many patients have also indicated their confidence in the program by noting that they receive services in an efficient manner. It does not matter where the person is, whether at the grocery, at office or on vacation, a virtual doctor’s visit is available to them and convenient. All that is required is for the patient to contact a health care organization through websites or mobile phone and get diagnosis and prescriptions of medication. Then the patient can get the prescribed drugs from a nearby local pharmacy