Essay: Patient Centered Medical Homes (Pcmh)

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[. . .] Here the focus of the medical staff remains on the issue or disease that has brought the patient to the hospital. However, the notion of medical homes ensures that people receive health care by expert practitioners who are equivalently good as private doctors and their focus does not only remain on the disease or illness but they focus on the entire human body and follow up with the patients with checkups on regular basis. This allows the people to attain the facility of quality health care whilst paying small amounts of money for treatment s as compared to those charged by the private practitioners. Thus, the basic problem that is intended to be solved by the legislations and policies regarding medical homes is the inability or insufficient accessibility to quality health care that is affordable by the citizens of the United States of America.

The concept of Patient Centered Medical Homes, as mentioned earlier, has been slow to become a major part of the health sector in the United States. But gradually this idea has grown into a solid reality throughout the country and by the end of April 2013, over 40 states have successfully adopted the policies and the programs to develop and further grow the medical homes (NASHP, 2013). The federal government of the United States and the states themselves have presented and passed a number of legislations and policies in recent years relating to the promotion of medical homes throughout the country. One of the very first legislations signed on the federal level was the bull passed by the U.S. Congress in 2006, titled the 'Tax Relief and Health care Act of 2006' (109-432, 2006). This bill mentioned a few rules and laws to setup the basic structures of the medical homes and also impacted upon the techniques and methods used to apply these legislations. This bill mentioned that the development of medical homes was to be done based on the careful planning and coordination amongst the parties involved in the medical homes sector of health care. It further mentioned that the medical homes would be required to use the health information technology to grow as a more advanced and efficient system of health care in the country in the years to come. This technology would allow the physicians and nurses to provide the patients with high quality medical care whilst educating them about the techniques to self work toward treating the diseases. This legislation also asked for the introduction of the individual health assessments and management's planes in relation to the medical homes. The legislation also discussed about the prospective fee for care management to be charged by the medical homes and to be paid by the general public. The passing of this bill had several impacts on the development of the medical homes in the country. Demonstrative medical homes were established to support the people throughout the United States. But these demonstrations were for the Medicare beneficiaries who were on the list that established the level of the people who were regarded as 'high need'. These demonstrations were run set up to run for 3 years and in around 8 states. A mixed set of locations were chosen to demonstrate the differential impacts of the medical homes in different localities and also included a mixture of types of practices done by the existing practitioners and nurses. The legislation also required for the care management systems to provide the prospective fee to be charged for the care management in the medical homes.

Further down the months, following in the footsteps of the U.S. Congress, the state government of the Louisiana state presented a local legislation that aided with the establishment of medical systems within the state. In 2007, the Louisiana Act 243 explained the medical homes in a more refined and clear manner and stated its core features and functions. Medical homes were described as system of cares that incorporated the patient centered care and were PCP directed. The legislation also discussed about the preventatives techniques and the primary care so as to ensure that the patients could be more efficient and take keen part in their own health care. The legislation also mentioned about the need to establish an integrated system of specialists, PCPs (Primary Care Providers) and the hospitals so as to strengthen the laid down basis of the medical homes development. The immediate impact of this regulation was that the state health department was made responsible for the research and the establishment of the medical home care system in the state that would aid the population that was low income and uninsured, whilst being Medicaid members. Moreover, this legislation also required the department of health of the state to develop a more advanced methodology of making Medicaid reimbursements for those providers who were participating.

A different legislation, the Vermont Act that passed in May, 2007, outlined the definition and understandings of the medical homes based on the legislation or policy that was established by the U.S. Congress in the previous year. Additionally, this legislation explained that the patients were required to take care of themselves and get educated regarding their illnesses to ensure that preventative and/or precautionary measures were taken to avoid the need to visit a medical home, thus explaining the role of the patient as well in the proposed and developing health care system regarding the medical homes. The impact of this legislation was quite important as it required funding a demonstrative project of medical homes for the enrollees of the Medicaid, State Employee Health Plans and the Catamount Health. This demonstrative medical home expanded the range in terms of number of people to be treated as a higher number of people were the direct beneficiaries of the demonstrative project to be established. In July 2007, the state of Washington passed a bill that defined within it the medical home as a site of care as "a site of care that provides comprehensive preventive and coordinated care centered on the patient's needs and assures high-quality, accessible, and efficient care" (Thiessen, 2007). The impact of this legislation was that it required for the state health department to create a 5-year plan that detailed about the provision of a medical home to all the people enrolled on the state health plan. Moreover, this legislation required the state health department to design and establish patient centered medical homes for the old aged people, the disabled people and those who were blind. The special point about this legislation was that it emphasized on the reform of payments and setting the goal to allow the existing primary care providers to continue with their practice and focus in the better coordination of the health care relating to chronic diseases.

Evidently, the legislations on state levels have been different and have varied with the level of reforms and targets set. These legislations equivalently have had their pros and cons. One of the major pros of all the legislations has been that they have established the demonstrative medical homes for certain time periods. This would allow them to understand the nature of the medical homes and would be taken to determine the success of the health care system based on the medical homes as compared to the already existing health care systems. However, one of the major disadvantages of most of these legislations is that they fail to recognize the need to establish separate medical homes for the old and the disabled. On a personal note, the problem that has led to the reform towards medical homes-based health care structure being developed in the country truly has been such a problem that needed to be addressed effectively by the United States government. The problem was gradually increased the gap between the public health care and the private health care services that were more superior based on the treatments and expertise available. The legislations regarding the medical homes have served to dismantle such differentiation in the eyes of the public and make the poor and low income level members of the society to be able to afford high quality health care at affordable rates. Although, the concept of medical homes has been quite new to the people of the United States of America, it seemingly would prove to be an effective solution in the future for a better and efficient public health care system.

Bibliography

109-432, P.L. (2006, December 20). TAX RELIEF AND HEALTH CARE ACT OF 2006. Public Law 109-432 (109th Congress) .

Backer, L.A. (2009). Building the Case for the Patient-Centered Medical Home. Family Practice Management 16 (1), 14-18.

De Geest, S., Moons, P., Callens, B., Gut, C., Lindpaintner, L., & Spirig, R. (2008). Introducing advanced practice nurses/nurse practitioners in health care systems: a framework for reflection and analysis. Swiss Medical Weekly (138), 621-628.

NASHP. (2013, April). Medical Home & Patient-Centered Care. Retrieved from The National Academy for… [END OF PREVIEW]

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