If you're anything like me, you may need at least two hands to count the number of healthcare professionals you work with: general practitioner, endocrinologist, diabetes educator, nutritionist, psychologist, ophthalmologist, optometrist, gynecologist... Whew! I can barely keep up with them all and you can bet they don't keep up with each other.
This lack of structured communication is one of the issues the Patient-Centered Medical Home (PCMH) hopes to address. We've written about this disruptive healthcare concept before, but the it recently got quite a lot of discussion time at this year's American Association of Diabetes Educators (AADE) Annual Meeting.
Now, these may sound like some new type of clinic, or even an extended stay place like a hospice, but a PCMH is more of an idea than a physical location. The idea has been met with a lot of resistance because it pretty much restructures how healthcare is currently handled, i.e. doctors seeing as many patients as they can in-office. It might not be a new concept — the phrase "patient-centered medical home" is actually 30 years old! — but it hasn't been widely adopted just yet.
So what exactly is a PCMH? Clinics or hospitals that become a PCMH run a particular kind of ship: a patient-centered ship (bet you didn't see that one coming!). A PCMH is when a clinic is built around developing a deeper, more holistic relationship between patients and their primary care doctors. And if you see more than one doctor (like an endo and a gynecologist) then they all will coordinate the patient's care by efficiently using electronic medical records (EMR). The idea is that to make a clinic or hospital patient-centered, all of our doctors will already be up to speed on what's going on in our health so that during visits we can focus on the issues, rather than answering unnecessary, repetitive questions or undergoing unnecessary tests.
For a deeper look at a PCMH, check out this introductory video from the folks at the Patient-Centered Primary Care Collaborative, an organization advocating for the adoption of the PCMH.
But there are challenges to the PCMH. The biggest is reimbursement. A PCMH relies more on the phone and Internet, while insurance fee structures remain set up to only handle in-person appointments. Insurance companies will have to adopt new ways of paying for services. Another challenge is getting physicians and other healthcare professionals fully trained on the new logistics and technology. As we all know, many clinics are still using paper charts and are not used to coordinating with other doctors or offices, so switching things over to a PCMH structure will take some time.
At the AADE conference, Dr. David McCulloch from Seattle's Group Health, a non-profit healthcare system that runs as a PCMH, answered a few questions about how they make it work. Every clinic that implements a PCMH will look at a little different, but McCulloch gives his insight into how a PCMH benefits people with diabetes (in a cute Scottish accent, no less!).