Overview

The recent demand for quality healthcare service has resulted in many healthcare professionals wanting to make the best strategies for health promotion and better delivery.  Patient-Centered Medical Homes and value-based payment systems are the two most commonly used strategies to achieve better health quality and give better value to the patients. 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 sectors usually hold systems that ensure that there is accountability for the quality of care and request provided in the service delivery. The argumentfor improving healthcare efficiency and effectiveness has always been the main agenda for many physicians together with the methods of balancing between effectiveness and efficiency. As a consequent of the many 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 also adhere to policies of healthcare.

With an increasing demand for quality and transparency in healthcare payment and service delivery, the most critical issues in healthcare are the Trends in Patient-Centered Medical Homes and value-based payment systems; this paper will address these two ideas.

 

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 state of the primary care system has proven to be less efficient.[1] The most commonly used model of change is the patient-centered medical model. Consequently, the culture of medicine is changing. From the years 2006, the pharmaceutical sector have seen the changes in the role of primary physicians as well as the foundation of national care systems. These transformations have always had positive intentions of improving health outcomes and delivery. The changes have been accompanied by the dramatic shift in 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 them. The consequences of these shifts are the limited number of graduates who pursue primary care and an overall decline of programs that offer training for primary care graduates.[2]As the number of population continuously grow, the lack of primary caregivers is continuously becoming a significant concern. The specialty has 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. The following are the evolutionary trends s in Patient-Centered Medical Homes and value-based payment systems

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 incentive 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 the 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 risky operations in the hospital. It is important to differentiate between performance risk and insurance risk in the medical sector. Insurance risks apply while spreading the financial burden over companies or diseases to many companies. Healthcare plans and insurance companies allow the state laws to give financial reserves that can take on insurance risks.

 

Care Deliveries, Management system, and Coordination

Different methods are used in achieving the outcomes expected in the reform of value-based budget. The primary care must show the key components providing quality care management across all the medical sections. Quality improvement gives a foundation for experiences and practices that can meet the outcomes needed and perform the way the healthcare system requires it. 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 are uniting various professionals with their patients to prevent illnesses and to treat them as well. Even though the patient perspectives are critical to implementing this model successfully, it has always been a question as to whether the practices are truly community-based. Whether the planners and physicians, together with the other professionals take the importance of integrating the knowledge of the questions in medical care seriously is still unknown.

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 costs 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 idea is to treat the patients and administer the treatments at their homes without necessarily moving to the hospital. Patient-centered medical are when considering the demands of the patients in this regard enhancing primary care. The philosophical changes generally elevate the quality of delivery and the adequacy of the care. It has proven to be among the healthcare service changes and have improved on the delivery.

Becoming Patient-Centered

Becoming patient-centered involve giving the service to the patients while they are at their homes according to Dickson et al. [4] Patient-centered medical have given an option to realize treatments that drift away from the providers and towards their communities.[5] The primary care providers have to involve designing the interventions that are used to perform the treatments. When it comes to the health care leaders, they have to make healthcare systems provided and those that are sustainable. However, they have to those that are 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.

Services make the full use of the 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 the wholeness of a person.  Patient-centered homes have to be supported by the initiatives from the community, the health institutions and the patients themselves according to studies done by Pereira et al.[6]

 

Community-based additives

Theoretically, patient-centered medical services engage the participants in health care through different community-based additives. This practice is 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  addressing the effectiveness of patient-centered medical homes and outcomes

 

The first study that addresses patient-centered homes concerning the model of the community is Bachmanwho recommends taking into consideration the opinions of the patients together with the members of the community.[7] Dickson also talks about healthcare financial management n hoe based care and recommends that chronic patients have to be offered treatments in their homes for a better outcome.[8] Articles that are relevant to patient-centered medical homes are available in the databases such as Medellin, PubMed and Cochrane library.[9] 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 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. Dickinson, Robert, David, Fairchild, and Alan recommends that multimorbidity diseases can be handled from afar through the use of effective technology.[10] Often, the patients suffer from a poorly rated quality of life and physical health. When this is added to the mental perspective of healthcare, it 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 prevent multi-mobility through the integrated team and have provided 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 various unities. The general practitioner and the patient work together coordinate patient-centered care that will help with the longtime management of chronic diseases. Various systematic reviews outline the assessment of some of the most effective and available patient-centered medical home services are mostly applicable to the management of chronic diseases. These findings are also useful for the primary caregivers especially when it comes to the transformation of the 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 base 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. The value-based payment has proven to reward not only the patients but also improve the trust and relationship between the patients and the health professionals.[11] The new payment methods incorporate other payment methods 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 and has encouraged the door to 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. patient-centered medical research is aninnovation 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 1960s, and the concept of medical homes have continuously grown over the past decades. 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.[12] 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.[13]

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. [14]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 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.[15]The same study also shows the massive development and integration of mobile technology to deliver services.[16]This allows for remote access of the patients through telemedicine and 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 homes have had numerous trends that have guaranteed numerous improvements 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 stay and will prove to be crucial in all the years to come.

Bibliography

 

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.

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.

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.

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.

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

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.

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.

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.

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

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]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.

[4]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.

 

[5]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.

 

[6]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

[7]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.

 

[8]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.

[10]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.

[11]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.

 

[12]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.

[13]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.

 

[14]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.

 

[15]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.

 

[16]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

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