along with Medicare and Medicaid

The Patient-Centered Healthcare Home

what is the Medical Home Concept?

concurrentlythe medical home concept has its origins in pediatric care, the concept has expanded since the overall healthcare system has contemplated the shift from some degree of interest on episodic acute care to some degree of interest on managing the fitnessof defined populations, especially those living with chronic fitnessconditions.

Several seminal commentaries influenced thinking about how team-based care mayimprove clinical care and attain optimal population health, establishing the basis for a more detailed conceptualization of the medical home:

> The Chronic Care Model, a structured techniquefor clinical developmentthrough team based care supported by an organizational and datatechnology infrastructure,Michael Turner Jersey, that may be the basis for the Bureau of basicfitnessCare's (BPHC) fitnessDisparities Collaborative.
> The Institute of substances's (IOM) first Quality Chasm report which articulated Six Aims and Ten Rules to steer the redesign of healthcare, including the importance of team-based care. This roadmap for improving quality inside the healthcare system stated that healthcare want to be safe, effective, patient-centered, timely, efficient, and equitable. The Chronic Care Model, fitnessDisparities Collaborative and Quality Chasm Aims and Rules are described in Appendices A and B.

Building on this foundation, the yank Academy of Family Physicians, American Academy of Pediatrics, American schoolof Physicians, and American Osteopathic Association released their Joint Principles of the Patient-Centered Medical Home in 2007.

> non-publicphysician - each patient has an ongoing relationship with a non-publicphysician trained to offerfirst contact, continuous, and comprehensive care.
> Physician directed medical practice - the non-publicphysician leads a team of individuals at the practice level who collectively take responsibility for the ongoing care of patients.
> Whole person orientation - the non-publicphysician is responsible for professionalfessionalviding for all the patient's healthcare needs or taking responsibility for appropriately arranging care with other qualified professionals. This includes care for all stages of life: acute care, chronic care,Donovan McNabb Jersey, preventive services, and finishof life care.
> Care is coordinated and/or integrated across all elements of the complex healthcare system (e.g., subspecialty care, hospitals,Chris Johnson Jersey, home fitnessagencies, nursing homes) and the patient's community (e.g., family, public and private community based services). Care is facilitated by registries, datatechnology, fitnessdataexchange, and other means to make sure that patients get the indicated care when and where they need and desireit in a culturally and linguistically appropriate manner.
> Quality and safety are hallmarks of the medical home.
> Enhanced access to care is in the market through systems this kind ofs open scheduling, expanded hours, and new featuresfor communication between patients, their non-publicphysician, and practice staff.
> Payment appropriately recognizes the added priceprovided to patients who've a patient-centered medical home.

Barr recently summarized the reason for the patient-centered medical home, pointing to the unwarranted variation in our nation's delivery of healthcare and the l. a.ck of relationship between what's spent and the preferredof the facilitiesthat are delivered. He also notes that, concurrentlyresearch suggests a robust basiccare system is a large characteristic of an efficient and high-quality healthcare system, the U.S. basiccare system is uncertain, maybeon the subject of break down.

by comparisonbackdrop, Barr reviews the fast-paced progressionof activities to test medical home models and the institutionof coalitions that include medical prosocieties, large employers, fitnessplans, and government agencies. The pace has quickened since 2006 when the Medicare Medical Home Demonstration Project was authorized inside the Tax Relief and fitnessCare Act. Spurred by the Medicare legislation, large fitnessplans, along with Medicare and Medicaid, are moving ahead with demonstration projects to test new payment methods and skimthe preferredand priceadvantages of the model. This speaks to the shared need to develop delivery and reimbursement models dclothethe fastcomings of the healthcare system: "a practice recognized as a patient-centered medical home would receive repaymentfor the time and work physicians spfinishto offercomprehensive and coordinated services. this systemis distinctly diffehirefrom the existing system which pays for professionalfessionalcedures and treatment of persondiseases versus valuing and galvanizing treatment of all of the patient, preventing chronic illness, and managing multiple, interrelated and ongoing illnesses."

In early 2008, the National Committee for Quality Assurance (NCQA) announced the improvementof standards for medical practices that need to be certified as patient-centered medical homes. The NCQa physician Practice Connections and poptient-Centered Medical Home fabricsarticulate nine Standards for practices to meet, including use of patient self controlsupport, care management,Tim Hightower Jersey, evidence-based rulesfor chronic conditions and serve as reporting and improvement.

Why is Care controlImportant?

at the core of the patient-centered medical home clinical techniqueis team based care that provides care controland supports people inside the ir self controlgoals. In a report prepared for the typicalwealth Fund, care controlwas identified as being one of the maximumfew policy featuresthat hold promise not simplyof containing costs but as well as of improving fitnessresultsfor high-risk populations.

"Care controlis the coordination of autoe so that you can lessenfragmentation and unnecessary use of services,Jimmy Clausen Jersey, prevent avoidable conditions, and promote independence and self-care. Alternatively referred to ascomplexcare management, targeted case management, high-cost or high-risk case management, care coordination, disease management, and other terms, care controlcoursesmanifest themselves in every kind of the best way. in one project, care controlencompassed personalized nurse counseling, pharmacy review, utilization management, case management, and depression controlprograms."

This emphasis on self-care resonates with the behavioral fitnesssystem's movement towards a Recovery and Resilience orientation, utilizing approaches this kind ofs the up to dately revised Wellness controland Recovery program or Copeland's Wellness Recovery Action Plan. With these models, the behavioral fitnessfield has developed structured approaches that strengthen the individual's capatownto set goals for improved self controlof expressconditions and to problem solve barriers employingthe resources of the community and non-publicsupport systems at the side of formal services. These approaches are critical to meeting the needs of people living with serious mental illness along with chronic fitnessconditions.

The five clinical purposesof the care manager, as identified inside the BPHC fitnessDisparities Collaborative, are:

> Develop and maintain rapport with patient and provider
> teachthe patient and the family
> Monitor symptoms and communicate findings to provider
> Develop and maintain a self-care action plan
> Maximize adherence to the treatment plan through negotiation of solutions to treatment-emergent problems

Unlike disease controlmodels with arms-length, telephonic care management, inside the Chronic Care Model and poptient-centered medical home the care manager is embedded inside the clinical team.

The community fitnesscenters participating inside the fitnessDisparities Collaborative have also identified the importance of enabling facilitiesin helping engage and support individuals with chronic fitnessconditions. These are not anyn-medical facilitiesthat facilitate access to timely and appropriate medical care, including transportation, language assistance, case management, and community outreach and education. This set of activities is ancillary to the focal pointed care controltask of monitoring fitnessprestigeand calibrating care for an personand that may be sometimesnot performed by the care manager. However, the team's success in managing chronic fitnessconditions depends on the sourceof these enabling facilitiesalongside the clinical services.

Care controlis the key to transforming a healthcare system geared towards acute problems into no less than one thinking a fewddressing fitnessneeds from a longeritudinal perspective (i.e. managing chronic illness and facilitating preventative self-care). Longitudinal monitoring and timely response to the methodillness is how care controltransbureaucracytreatment as usual. This take care of ongoing accountskilland responsibility for individuals being cared for want to be prominentfrom old ideas about "gatekeeping" access to care-a undeniableion confounded by the varying methodsin which the terms care manager and case manager were utilized in side the l. a.st 20 years.

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