Overview

The recent demand for quality healthcare services has called for many healthcare professionals calling for the best strategies that can be used to promote better health delivery.  Patient-Centered Medical Homes and value-based payment systems are the two most commonly used strategies that have been improved for a longtime. Value-based payment model refers to the arrangement of payments that are used in paying physicians and medical groups as well as other health care providers depending on the measures of quality, efficiency and positive experiences for their patients. On the other hand, patient-centered medical homes apply when the patients are given the medical service at their home in which they have partial discussions on and they are part of the debate. The concepts of value-based payment come as a result of a relationship between the government employees and customers who pay to get quality services. The public and private usually hold systems used in healthcare delivery accountable for the quality of care and request provided in the service delivery. The urgeto improve healthcare efficiency and effectiveness have always been the main agenda of many physicians and how to balance between effectiveness and efficiency. Because of the technicalities and ethical challenges experienced during the value-based payment, it is always imperative for the physicians to use the most transparent methods and models that are theirs to the policies of healthcare.This paper will address some of the most critical issues on the Trends in Patient-Centered Medical Homes in value-based payment systems.

Patient-Centered Medical Home trends in Primary and Specialty Care and the involved changes

 

Effective primary care systems are crucial components of the healthcare system. However, the current states of the primary care system have proven to be less efficient.[1] The most commonly used model of change he is patient-centered medical. Constantly, the culture of medicine is changing. The first fifteen years have seen the role of primary physicians as well as the foundation of national care systems undergoing various remarkable transformations. These have been accompanied by the dramatic shift of quality that emphasizes on the patient-physician relationship. For a long time, the relationship between the physician in the patient was a crucial component of health care delivery. However, these remarkable changes have transformed this relationship making it difficult for the interaction to continue the way it was. The consequences of this shift are the limited number of graduates who pursue primary care and an overall decline of programs that offer training for these options.[2]As the number of population continuously grow, the lack of primary caregivers is continuously becoming a great concern. The specialty is have also been affected by these trends and will continue to change.These evolutionary trends have taken their toll on the value of care that is given by the healthcare providers.

 

Value-Based Contracting

The main aim of value-based payment is to give the suffering population and health care management results that can improve on the service and are cost effective. Value-based payments provide an alternative payment model that is arranged to create a combination of disincentive attendance and incensive that encourage better healthcare provisions through performance measures. Value-based payment increase investment in primary care and it is necessary to enhance the population management. Increased investment in primary health care provider can also be structured to blend with their models listed in value-based contracting. The most notable change that has been realized is the value-based contact trend and the exposure that the physicians get when performing risks and using unnecessary services.

It is important to differentiate between performance risk and insurance risk in the medical sector. Insurance risks that are spreading their financial burden over injuries or diseases too many companies for people. Healthcare plans and insurance companies other their state laws to give financial reserves that can take on insurance risks.

 

Care Deliveries, Management system, and Coordination

To achieve the outcomes that are expected and reform value based budget, the primary care must show the key components that provide quality including care management across all those medical neighborhoods. Quality improvement gives a foundation for experiences and practices that can meet the outcomes needed and perform the way it is required by the healthcare system. Focusing on health outcomes requires infrastructure and support from the population and health manager together with their management that is risk-stratified. This is focusing on individual care support for the patients and allowing state assessment procedures of the app that is existing in terms of needs and resources. For the patients who have complex conditions, the physicians responsible for primary care have to collaborate with other specialists and care providers to give questions about the services through the use of effective communication.

 

Themes in mature patient-centered-medical-homes

Within the last two decades, there has been increased attention devoted to the role played by primary caregivers in improving the health status of the population. The innovations are patient-centered medical that areuniting various professionals with their patients to prevent illnesses and to treat them as well. Even though the patient perspectives are quite critical to implement this model successfully, it has always been a question as to whether the practices are truly community-based. It is always a question as to whether the planners and physicians, as well as other professionals, take the importance of integrating the knowledge of the questions in medical care seriously. The arguments are based on the community-based philosophies but are also fundamental to the perspectives of health care workers and community members. Because of the cost of healthcare that is quite high, it is important to find a way to evenly distribute the coasts and also to avoid disparities that are already existing.[3] One of the remedies that have been proposed for this solution is the patient-centered medical home. The national medical quality assurance recognizes practices that are patient-centered that are done to transform practices of primary care into what the patients want. Patient-centered medical are crucial in taking into consideration the demands of the patient’s and in this regard enhances primary care. The philosophical changes generally and dust to elevate the quality of delivery and the adequacy of the care. Best healthcare services have to be timely and relevant so that they are able to help their patients effectively.

Becoming Patient-Centered

There have been several criticisms about the current healthcare systems that are not meeting their patient requirements. Patient-centered medical have given an option to realize treatments that drift away from the providers and towards their communities.[4] The primary care providers have to involve divisions in designing the interventions that are used to perform the treatments. When it comes to their health care leaders, they have to make healthcare systems provided sustainable irrelevant thereby reducing the cost and revamping healthcare for the good of the people especially when it comes to those that are affected by the cultural side of treatment.

Patient-centred made jubilee new healthcare model that is based on primary care. It is a system that gives a dependable service and a holistic service to the patients who are chronically ill. This model has been adapted to offer accessible and comprehensive care that can be continuous even when the patient is not around the hospital. Patient-centered medical homes have a goal of transforming medicine and meet the aim of individuals in regards to a whole person. Every medical decision that is made in this manner have to take into consideration the decisions by the patients, family members of the patient and their caregivers. Medical information has to be shared in addition to ever sizing the relationship that exists in healing and treatment.

 

Community-based additives

Theoretically, patient-centered medical our committed that participate in health care even though this activity cannot be through the participation. This practiceis always limited to other ideas such as limited consultation especially when the partnership is not desired. Even though consultation may be sufficient as with some emotional support, the entire process of involving the community and the patients are always complicated. It is important to note that this model is based on a maneuver that is philosophical and has remained an integral part of the discussion about patient-centered medical homes. Social reality is encountered during the construction of community-based additives. Interpreting the behaviors and events are also important ideas that have to be considered when conceptualizing these ideas and practical terms.

Studies are addressing the effectiveness of patient-centered medical homes and outcomes.

Various studies address the effectiveness of patient-centered medical and their outcomes. Most of these studies are based on the models of primary care and their standard care that takes into consideration the opinions of the patients together with the members of the community.[5] These studies are relevant to the patient-centered medical homes model and how effective they are compared to treatments offered in healthcare institutions for chronic disease patients. Articles that are relevant to patient-centered medical homes are available in the databases such as MedellinPubMed and Cochrane library.[6] Most of these studies used quantitative data that are put together with statistical meta-analysis to calculate the effectiveness of these services. The burden of health placed upon medical institutions by the noncommunicable diseases as well as the most common two disorders has increased in the recent past. Several treatment strategies are complex are designed for specific diseases such as ischemic heart disease and chronic obstructive pulmonary diseases together with lung cancer and muscular disorders. The growing burden presents a massive challenge to the health care systems all around the globe requiring the need to explore the best strategies that can be employed to manage these diseases. Civilization swede multimorbidity diseases have needs that are quite challenging to their primary caregivers for numerous reasons.[7] Often, the patients suffer from a poorly rated quality of life and physical health. When this is added to the mental perspective of healthcare, the bad and even becomes difficult to handle. In addition to this, the multimorbidity is also associated with increased hospitalization procedures and polypharmacy services that have proven to be inappropriate. Strategies and interventions that can improve the quality of performance of the general healthcare practice can help the patient outcomes improve and also used a massive reduction in avoiding the use of healthcare facilities thereby reducing the overall cost of healthcare.Primary care is the ideal place facilitating, coordinating and managing chronic diseases. Several strategies to prevent multi-mobility true integrated team and a long time disease management approaches that can adequately address the complex care needs of the patients at home. This patient-centered medical home care was first introduced in the year 1967 and have been successful when it comes to taking care of patients with multiple unities. The general practitioner and the patient work together to coordinate patient-centered care that will help with the longtime manager of the chronic disease.Various systematic reviews outline the assessment of the most effective and available patient-centered medical home services that are used in the care for chronic management. These findings are also useful for the primary caregivers especially when it comes to the transformation of a while an ocean of changes and structural practices that have taken place through the time.

patient-centered-medical-homes in a value-based payment system. 

Patient-centered medical homes have numerous payment approaches that can encourage the sustainability and transformation of medical practices. This takes place through incentivizing efficient care and support ghosts that have been reimbursable in the traditional perspective. Traditionally, the fee-for-service method was used to rewards the service over the value from the patients. Currently, there are new payment models that have been designed to support and encourage the delivery of high-quality services especially when it comes to primary and preventive services. This rewards and improved health outcome and stabilize the total healthcare cost.[8] The new payment methods incorporate free for service payment such as monthly coordination fee and fixed additional fees and in many cases a different form of paper performance payment. The care coordination payments are covering the expenses that relate to the healthcare teams and occurs outside patient encounter. Pay-for-performance also saves the arrangement of rewards by providing and achieving efficiency goals. Most of the payment rates depend on factors such as patient population and practice size together with the proportion of high patient needs.

 

Improvement and investing in primary care is a major strategy that is important to observe and achieve the health policy of the republic and improve on sustainability by providing value to the services. The health care system has grown from the fragmented and expensive services two doors services that are affordable by the public. Most countries that have efficient and effective systems usually prioritize primary healthcare and are more aligned to the workforce policies. The primary care services service entry point while delivering coordination for patients and families. Research, patient-centered medical is a novation that requires transparency in terms of payment. This innovation is designed to improve the experience of the patient and encourage their population health thereby reducing the cost of care. Primary care originally dates back to the year 1960 the concept of medical homes have continuously grown over the past decade. These services support the patients to learn and manage the development of their care plans and to coordinate all their healthcare systems comprehensively.

Use of telemedicine in patient-centered-medical-homes.

Telemedicine refers to the use of information technology together with communication to give clinical services to the patients at their home from a distance.[9]Telemedicine has overcome barriers that are brought about by distances as well as improving access to other medical services that would often be unavailable without them. Telemedicine often uses technologies to save lives in critical conditions and emergencies. Even though there have been numerous precursors to telemedicine, it has become an important part of the 21st-century incorporation of information communication and technology in healthcare. Telemedicine technologies allow communication between the patient and the health care providers with ease and convenience. They also provide and transmission of medical images and health care data from one place to the other.[10]

There have been earlier forms of telemedicine that were performed through the use of telephone and radios supplemented by video telephony. Currently, the advanced diagnosis has been used to distribute server applications and implement telemedical services and devices that support in-home care services. It is always recommended for healthcare providers to have an environment where the conditions of provision are seamless with pediatricians together with their teams significantly texted less time to transfer information from themselves to the patient and their families. The ease of transferring information from their provider to the patient makes it easier for the professionals to pass the message across especially if the patients are in an enclosed environment. These are situations where all the other unnecessary investigations and referrals are avoided as well as costs being saved for the patients. It has become an important facet where telemedicine and patient-centered medical home comes in. Comprehensive delivery of health requires efficient and effective healthcare that has the least expensive in its concept. Patient-centered medical implies that the record is given at the home of the patient with ease of monitoring and cost-effectiveness.[11]Physician shortages and the barriers of s geography makes it necessary to have home-based services and supplementary technologies that can perform the same role as a medical institution.These services also decrease costs and increase access while improving the patient outcome. The use of patient-centered medical homes has the potential of meeting all the goals including increasing access to services decreasing the costs and improving the patient outcomes.  In most cases, the first recommendation comes while creating a template and a business model for various physicians to ease their complexities and implement elaborate system care.Telemedicine has proven to be beneficial to the patients who are isolated in communities that cannot access the services well and those that are coming from the regions that are known to be remote. These communities can also receive care from specialists while they are traveling for when they are far away.[12] The recent development in telemedicine has seen the collaboration with mobile technology and health care professionals that come from far locations to share information that are crucial and also discuss ideas and issues with their patients who are not in the same place with them. Telemedicine allows for remote monitoring and patient care through the use of mobile technology that can help reduce the need for old patients to visit hospitals and also enable remove prescription and drug administration by the doctors. This potentially reduces the overall cost for the medicine as well as the overall transport cost. It is also preferable for the patients that have limited mobility and access to transportation systems to interact with their doctors through telemedicine. Patients with less mobility including those that are suffering from Parkinson disease can also get assistance from the experts without necessarily having to move to the health care facility. Telemedicine has eliminated the transmission of infectious diseases and other infectious parasites that can be conducted between the patients and the medical stuff. This has been an issue in the medical sector where patients feel comfortable when they are in remote locations.

 

conclusion

 

In conclusion, patient-centered medical have been proven to be an important fact of healthcare with guaranteeand improvement in primary care delivery. This paper has addressed some of the most critical issues affecting the patients and their caregivers together with the healthcare professionals. The new method of payments reduces the cost of healthcare provided and guarantee quality. Patient-centered medical is more effective and improves clinical outcomes especially for patients with chronic diseases and other noncommunicable illnesses.  Even though the strength is not clear, there have been several kinds of literature that support this model of treatment. It leads to authentic participation by the individuals that allows them to communicate their realities with their caregivers. Hence, Patient-Centered Medical Homes in value-based payment systems are there to be improved in the media sector

 

Bibliography

Lavallee, Danielle C., Kate E. Chenok, Rebecca M. Love, Carolyn Petersen, Erin Holve, Courtney D. Segal, and Patricia D. Franklin. “Incorporating patient-reported outcomes into health care to engage patients and enhance care.” Health Affairs 35, no. 4 (2016): 575-582.

Pereira, Vincent, Meghan Hufstader Gabriel, and Lynn Unruh. “Multiyear Performance Trends Analysis of Primary Care Practices Demonstrating Patient-Centered Medical Home Transformation: An Observation of Quality Improvement Indicators among Outpatient Clinics.” American Journal of Medical Quality (2018): 1062860618792301.

Bachman, Sara S., Meg Comeau, and Thomas F. Long. “Statement of the problem: health reform, value-based purchasing, alternative payment strategies, and children and youth with special health care needs.” Pediatrics 139, no. Supplement 2 (2017): S89-S98.

Dickinson, Robert A., David Fairchild, and Alan London. “building a magnet physician enterprise: a critical health system priority in the value market.” Healthcare Financial Management 72, no. 11 (2018): 44-51.

Dickinson, R.A., Fairchild, D. and London, A., 2018. Building a magnet physician enterprise: a critical health system priority in the value market. Healthcare Financial Management, 72(11), pp.44-51.

Robinson, J.C., 2017. Value‐based physician payment in oncology: public and private insurer initiatives. The Milbank Quarterly, 95(1), pp.184-203.

Maeng, Daniel D., Nazmul Khan, Janet Tomcavage, Thomas R. Graf, Duane E. Davis, and Glenn D. Steele. “Reduced acute inpatient care was the largest savings component of Geisinger Health System’s patient-centered medical home.” Health Affairs 34, no. 4 (2015): 636-644.

Burwell, Sylvia M. “Setting value-based payment goals—HHS efforts to improve US health care.” N Engl J Med 372, no. 10 (2015): 897-899.

Handunge, Valerie, Nathan Riner, MagdelineAagard, and Ronald Riner. “Adopting new cardiovascular models to achieve value-based care.” Physician leadership journal 3, no. 2 (2016): 34-43.

Farmer, S.A. and Brown, N.A., 2017. Value-Based Approaches for Emergency Care in a New Era. Annals of emergency medicine, 69(6), pp.684-686.

Saucier, Ashley N., Danielle McMechan, Julie Dahl-Smith, Carla Duffie, Denise Hodo, Holly E. Andrews, and Joseph Hobbs. “Evaluation of trends in diabetes care in a patient-centered medical home.” Journal of the Georgia Public Health Association (2017).

 

[1]Saucier, Ashley N., Danielle McMechan, Julie Dahl-Smith, Carla Duffie, Denise Hodo, Holly E. Andrews, and Joseph Hobbs. “Evaluation of trends in diabetes care in a patient-centered medical home.” Journal of the Georgia Public Health Association (2017).

 

[2]Saucier, Ashley N., Danielle McMechan, Julie Dahl-Smith, Carla Duffie, Denise Hodo, Holly E. Andrews, and Joseph Hobbs. “Evaluation of trends in diabetes care in a patient-centered medical home.” Journal of the Georgia Public Health Association (2017).

 

[3]Handunge, Valerie, Nathan Riner, MagdelineAagard, and Ronald Riner. “Adopting new cardiovascular models to achieve value-based care.” Physician leadership journal 3, no. 2 (2016): 34-43.

 

[4]Farmer, S.A. and Brown, N.A., 2017. Value-Based Approaches for Emergency Care in a New Era. Annals of emergency medicine, 69(6), pp.684-686.

 

[5]Bachman, Sara S., Meg Comeau, and Thomas F. Long. “Statement of the problem: health reform, value-based purchasing, alternative payment strategies, and children and youth with special health care needs.” Pediatrics 139, no. Supplement 2 (2017): S89-S98.

[7]Dickinson, Robert A., David Fairchild, and Alan London. “building a magnet physician enterprise: a critical health system priority in the value market.” Healthcare Financial Management 72, no. 11 (2018): 44-51.

 

[8]Burwell, Sylvia M. “Setting value-based payment goals—HHS efforts to improve US health care.” N Engl J Med 372, no. 10 (2015): 897-899.

 

[9]Lavallee, Danielle C., Kate E. Chenok, Rebecca M. Love, Carolyn Petersen, Erin Holve, Courtney D. Segal, and Patricia D. Franklin. “Incorporating patient-reported outcomes into health care to engage patients and enhance care.” Health Affairs 35, no. 4 (2016): 575-582.

 

[10]Pereira, Vincent, Meghan Hufstader Gabriel, and Lynn Unruh. “Multiyear Performance Trends Analysis of Primary Care Practices Demonstrating Patient-Centered Medical Home Transformation: An Observation of Quality Improvement Indicators among Outpatient Clinics.” American Journal of Medical Quality (2018): 1062860618792301.

 

[11]Dickinson, R.A., Fairchild, D. and London, A., 2018. Building a magnet physician enterprise: a critical health system priority in the value market. Healthcare Financial Management, 72(11), pp.44-51.

 

[12]Robinson, J.C., 2017. Value‐based physician payment in oncology: public and private insurer initiatives. The Milbank Quarterly, 95(1), pp.184-203.

Maeng, Daniel D., Nazmul Khan, Janet Tomcavage, Thomas R. Graf, Duane E. Davis, and Glenn D. Steele. “Reduced acute inpatient care was the largest savings component of Geisinger Health System’s patient-centered medical home.” Health Affairs 34, no. 4 (2015): 636-644.

 
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