The patient centered medical home (PCMH) was designed as a way to improve health by transforming how primary care is organized and delivered. Building on the work of a large and growing community, the Agency for Healthcare Research and Quality (AHRQ) defines a PCMH as a model of the organization of primary care that delivers the core functions of primary health care.
The concept of a PCMH is more than forty years old. As originally developed by the American Academy of Pediatrics, it described a pediatric practice that would coordinate all of the care for children with multiple medically complex problems, including birth defects, developmental disabilities, chronic diseases such as cystic fibrosis, muscular dystrophy, and the like. Recently, the PCMH has been revitalized as a concept because of the desire to find a way to have primary care physicians paid for developing infrastructure to coordinate care more effectively.
There are now thousands of PCMH projects across the country. Typically, they involve primary care practices, which generate a far higher level of engagement with their patients and coordinate care for them across other providers. In many ways, the PCMH model is what gatekeepers in HMOs in the mid-90s were supposed to do, but usually did not. One of the major focuses of PCMH practices is around chronic care and keeping patients out of the hospital. There is some data that, in fact, these approaches work. The NCQA and several other organizations accredit PCMHs around a range of structural attributes as well as process measures. These include using electronic records and evidence-based guidelines, identifying high risk patients, tracking and coordinating care, and measuring and improving performance. Typically, primary care physicians are paid an enhanced per-member per-month capitation payment for their PCMH activities.