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Ohio experiments with ‘medical home’ system for patients 

Stephanie Taylor Christensen

Advocacy groups in Ohio think they may have a solution for streamlining the state’s health care system — the patient-centered medical home (PCMH) model. A state law passed in 2010 set up a PCMH pilot program.

The PCMH model seeks to form a system where doctors focus on keeping patients healthy (and get rewarded for it) by creating a medical “home base” for each patient. Currently, health care providers make money on a “fee for service” model — a doctor sees a patient and is reimbursed by the patient’s insurance company. In other words, health care providers are rewarded for the quantity of patients they see, not the quality of care, according to Access HealthColumbus.

Key components of the PCMH model, which was endorsed by the American Medical Association in 2008, are:

  • The personal physician. This physician oversees the patient’s care, from acute care to preventive services, according to the Ohio Academy of Family Physicians (OAFP). The personal physician also acts as a team leader, coordinating a patient’s care with staff and other specialists at his or her facility.
  • Improved health information technology. Remote care tools and health care registry systems would assist coordination between the physician and other involved parties within the complex health care system, according to OAFP.
  • Reformed payment structures. According to a 2009 action plan from the Central Ohio Patient-Centered Medical Home Project, fee-for-service payments still would exist as a way to encourage face-to-face office visits. In addition, a monthly “care coordination” payment would be given to a facility by insurance companies if that facility has carried out certain practices and health care technologies that make care more efficient. Finally, insurance companies would reward facilities with “pay for performance” payments if they manage to reduce health care costs by keeping patients healthier.

Advocates of the PCMH system, like Access HealthColumbus and OAFP, say that the inefficiency in the current health care system amounts to a huge waste of money and resources. When health care providers have no incentive to improve and maintain the health of their patients, chronic conditions worsen and lead to huge medical bills.

According to its supporters, a PCMH system would allow physicians to share the savings that occur when the number of hospitalizations is reduced thanks to effective in-office care management. In addition, OAFP says, patients and their families will receive better care and overall service instead of being left to navigate the complex world of health care and insurance on their own.

Still, there are some challenges in such sweeping changes. Launching a PCMH system would require doctors to shoulder the expense of investing in new technology. It also would require Ohio health insurance companies to overhaul their reimbursement structures.

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