Patient Centered Medical Homes: A Strategy for Increasing Access to Care

Increasing access to quality primary medical care, especially for individuals with public insurance coverage, is a key component of improving health outcomes for many Americans.   Peterson et al (2011) compared the frequency of hospitalizations and emergency department (ED) use, lengths of stay, mortality rates and total health care costs for certain disease states (e.g. diabetes, asthma, vaccine preventable diseases, appendicitis and psychiatric conditions) for publicly insured or uninsured individuals and those with commercial insurance. 

Individuals with public insurance (primarily Medicaid) or no insurance have poorer health outcomes and significantly higher hospitalization and emergency department utilization rates than those with private insurance (Peterson et al,2011).  They are also far more likely to be hospitalized for high-severity illnesses and for conditions that may have been preventable with access to primary medical care (Peterson et al, 2011), resulting not only in poorer health outcomes, but also significantly higher costs.  Analysis done by Priority Health in 2007 showed the ED visit rate for Priority Health commercial members was approximately 200 visits/1,000; Priority Health’s Medicaid’s ED visit rate was 560 visits/1000 for Medicaid members under the age of 18.

Patient Centered Medical Homes (PCMH) have been shown to be effective in improving access to care and improving health outcomes.  Definitions and components of a PMCH vary.  One well-respected authority on PMCHs is the Agency for Healthcare Research and Quality (AHRQ).  The AHRQ considers the PCMH a model of delivering healthcare whereby care is coordinated through primary care providers (i.e. primary care physicians, nurse practitioners or physician assistants) to ensure care is received in a timely, culturally competent and effective manner (www. pmch.ahrq.gov). 

According to AHRQ, PCMHs have five functions and attributes.  They must be patient-centered, provide comprehensive care, coordinate care, increase access to care and have a systems-based approach to quality and safety (www. pmch.ahrq.gov).  In general, PCMHs focus on establishing partnerships between patients and providers, so comprehensive preventive and primary medical is provided in a culturally competent and efficient manner. 

While PCMHs are not a cure-all for everything that ails the healthcare system, they have a part to play in increasing access and quality, reducing costs and improving outcomes.