The Difference between Patient Centered Medical Home and Health Management Organization
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The Difference between Patient Centered Medical Home and Health Management Organization
Healthcare sector is one that have different approaches to service delivery, some being highly embraced while other methods only used by a few. The approaches to healthcare service provision, coverage, and reimbursement as much as they are several, have notable similarities and distinct differences in the manner of their implementation. The healthcare methodologies borrow from another, whereas some are directly contrary to others (Baron, 2010). The plans depend on the policies of a country and the burden of care that are designed in an appropriate manner to respond both to the economic and health needs in terms of the difficulty.
Patient-centered medical home is a concept of care where a primary physician coordinates the care required in the manner that the patient requires, in a place and time of preference focusing on quality. The approach has been adopted largely for the provision of primary care in the healthcare system where practitioners and care teams offer primary care services to a patient from where they are (Baron, 2010). As the name suggests, this type of care is patient-centered and is provided at any place of the patient’s convenience. The model coordinates partnerships between patients and their care physicians and if need be, their families. Other constructs such as the health information and technology aid in ensuring that the care process is appropriate for a particular patient (Bates & Bitton, 2010).
Health Management Organizations is a plan where all the services are paid for on a fixed prepaid basis, for all the care and hospitalization. The organizations provide a broad range of medical services to their clients ranging from consultations, hospitalization, and surgeries. All the services are provided by the care facilities within a network, and any other attention are provided on the recommendation of a primary physician. This control of care translates to the control of the rapid increase in cost and inculcates preventive measures.
The main difference between medical home and management organization is that the former is a healthcare service provision concept whereas the latter is an insurance plan. Health management organization focuses on reimbursement methodologies and insurance coverage as opposed to a medical home that focuses on service provision that is patient oriented (Rittenhouse & Shortell, 2009). In the medical home, the patient dictates the instance and the place where the primary care needed should take place. In management organizations, the insurer dictates the extent of care a patient can receive and the place where such services are offered.
As much as both the medical home and the management organizations have a primary provider, the roles differ. In the medical home concept, the main practitioner coordinates the primary care required by the patient and any other treatment needed on the preference of the patient and to an extent in liaison with the family (Hefner, Huerta, & McAlearney, 2014). In management organization, the primary provider acts as a gatekeeper to determine the services to be offered to the patient as well as where the services can be accessed. Again, the medical home system assures quality by the care planning process of the evidence-based medicine as opposed to HMO that focus on containing costs (Rittenhouse & Shortell, 2009). The payment for services under the medical home is comprehensive and covers all the care offered not limited to patient-provider interaction. While in one the services are paid for in advance because it is an insurance plan, the other is paid for after service delivery since service provision is coordinated than controlled.
Why Health IT, workforce development, and payment reform are critical for success of PCMH
The medical home model is focused on comprehensiveness, coordination of workforce, accessibility and quality and safety of care. Information technology plays a critical role in the intended coordination of services and the support of evidence-based care. Reform in payment will provide measures in ensuring that the payments are appropriately made for services.
Health Information Technology in Patient Centered Medical Home
Information technology aids in the coordination of services and coordination of the necessary elements of a healthcare system. Technology improves on accessibility through advanced innovation, electronic methodologies, and telephone (Bates & Bitton, 2010). Patient care is coordinated across all complexities encompassing healthcare delivery structures, the patients’community, and home. Information technology in healthcare supports registries, health information exchange and all the necessary requisites for assuring the patient has indicated care in an appropriate manner. The technology boosts the transfer of information between providers and relating the sequence of care. The technology support optimal patient care, measurement of care, transfer of knowledge to the patient and efficient communication.
Workforce Development
On another hand, patient-centered medical home focus on patient-centeredness that requires proper coordination and partnership among practitioners to ensure appropriate service delivery. The workforce development helps in ensuring that the decisions made relating to care takes into account patient needs and preferences. It also ensures that patients are offered education and support they require to make a participatory decision in their care appropriately (Bates & Bitton, 2010). The team of care providers offering services to a client has to be wholly accountable for the healthcare needs of a person and provide an appropriate response in the required manner. All the necessary care appropriate to an individual's need such as mental and physical needs, preventive and promotion care can only be possible if the workforce is properly constituted. The care has to be coordinated across the broader system through to specialty and primary services (Baron, 2010). The staff must ensure highest quality is upheld and that the families and patient decisions are well informed.
Payment Reform
The manners in which the patient-centered medical home services are designed, and provided require proper payment method. The payment system for the program has to be well designed either to fit the existing payment plans or have an own invented method. The care has provided for the accountability for the cost incurred in a way acceptable to every party. The payment systems have to support the incorporated form intended in the concept other than an integrated method (Rittenhouse & Shortell, 2009). The payments must be sustainable to support the proper relationship between a patient and the provider. The payment method has to recognize appropriately the value of the service added to the patients who receive service within the system. There is need for general transformation in the manner in which the reimbursement methodologies exist, and it has to be in a way sustainable with sufficient practice resources.
Patient-centered medical home is a concept that requires a whole transformation and development in the healthcare sector (Baron, 2010). As much as the system might be ready for or well fitting to the network, some issues have to be addressed to ensure that the intended purpose is achieved. Teamwork and Empowerment of employees will encourage feedback and transfer of information is necessary for the system. The payment method also has to be reformed as well to be appropriate for the concept and be sustainable to support the interaction of the process. If all factors are appropriately considered and aligned, greater success may be achieved for the system that is already acceptable to many (Hefner, Huerta, & McAlearney, 2014).