Patient-Centered Care for Aging Care Providers
Patient-centered medical homes (PCMH) represent a unique model of care that improves health care service delivery as well as introducing a varied pay schedule that promotes quality (capitated care programs) over quantity (Fee-For-Service). A common theme among PCMH advocates is the benefit to the patient, which is the number one priority in the health care system. PCMH will soon become a standard part of the American health system and will include services that were once never reimbursed by insurers. Specialized primary care services include mental and behavioral health; dental health; pharmacy services; day care/senior centers; transportation services; linguistic/translation services; educational and health promotion services; housing and employment opportunity assistance along with other forms of skill building.
Under the direction of Health and Human Services (HHS) and Human Resources Services and Administration (HRSA) health centers have served as large-scale models of the PCMH initiative. Currently 13% of health center programs have implemented PCMH but the goal is for 25% by 2015 (see chart below). Health centers are required to perform certain tasks before implementation begins. Several of these tasks include instituting an electronic health record system staff preparation conducting surveys.
PCMH Programs at Health Center Programs, U.S., 2012
Source: Health Resources and Services Administration, 2012
In 2004, The Future of Medicine released a list of steps to implementing PCMH. Many of the same steps are embedded into the HRSA 19 Program Requirements, which are regulations for health center programs.
Each of the components listed here are important steps to strengthening the capacity of health systems to provide integrated and comprehensive health services. Accrediting bodies such as The Joint Commission and the National Committee for Quality Assurance (NCQA) present information on to assist with systematic transitions and implementation of PCMH.
Outreach and PCMH
PCMH has several features that complement care delivery among aging populations. PCMHs are versatile because the needs of the patient superseded all other priorities. Therefore for older adults who may have several medical conditions or who may be considered “frail elderly”, health care needs can be met with fever providers outside of the medical home.
The change from “quantity to quality” has created an avenue for innovation in health care delivery. “Quality” outreach services may include a mobile unit that targets high populations of seniors, partnerships with senior centers to host group meetings and health-related events, and home visits. Services such as assisted-living facilities for seniors have helped to link home and community-based services with long-term care needs at a lower cost than nursing homes. Health centers such as OneWorld Omaha have also responded to the practical needs of seniors by offering housing and other forms of assistance.
Due to the fact that older adults are more likely to suffer from debilitating and degenerative health conditions such as dementia and cancers, specific health models have been created to assist PCMH health care providers. A few noteworthy examples are: dementia, diabetes, cancer, and HIV. For example, the Aging Brain Care (ABC) medical home model was specifically developed to care for the various health needs of older adults with degenerative mental health conditions such as dementia and Alzheimer’s. The ABC model recommends that a nurse practitioner, social worker, primary care physician and a geriatric health specialist work together to help aging patients manage mental health conditions.
PCMH programs to check out:
- Piedmont Access to Healthcare Services (PATHS)
- Hudson River Healthcare
- Codman Square Health Center
- Albany Area Primary Health Care
 Fox-Grage, W., Walls, J. (2013). State studies find home and community-based services to be cost-effective. Retrieved from http://www.aarp.org/content/dam/aarp/research/public_policy_institute/ltc/2013/state-studies-find-hcbs-cost-effective-spotlight-AARP-ppi-ltc.pdf