The Medical Home Model: New Opportunities for Psychiatry
Purpose of review The Patient-Centered Medical Home (PCMH) model is an approach to providing integrated healthcare through one main point of access. As the PCMH model gains increasing adoption in large health systems, its implications for psychiatric services are becoming increasingly important. This review highlights the development of the medical home model and a number of ways in which it has been adopted in psychiatric delivery systems.
Recent findings Numerous pilot initiatives have demonstrated quality improvement through the provision of psychiatric care in medical settings, medical care in psychiatric settings or fully integrated care through broadly trained providers.
Summary The PCMH model offers a useful conceptual framework for the management of complex and chronic psychiatric illness. Early pilots of its use in psychiatric settings have demonstrated that people with psychiatric illness who receive their care in a medical home have better access to care, improved response to treatment, and higher cost-efficiency compared with usual care.
Over the past 10 years, the momentum to increase alignment between the clinical, scientific, and administrative infrastructures of the US healthcare system, including mental health services, has been steadily building. In 2001, the Institute of Medicine (IOM) published Crossing the Quality Chasm: A New Health System for the 21st Century. This landmark report sparked a variety of efforts to measure the quality of the healthcare system with the intent to improve health outcomes and reduce preventable errors. In 2003, the President's New Freedom Commission on Mental Health issued Achieving the Promise: Transforming Mental Healthcare in America, which put forth specific recommendations on improving care at the interface between mental health and general medicine. The IOM followed up in 2006 with Improving the Quality of Healthcare for Mental and Substance-Use Conditions, which specified among its recommendations that providers of mental healthcare should increase collaboration between one another and government entities to facilitate the delivery of quality care. Most recently, the March 2010 signing of H.R. 3590, the Patient Protection and Affordable Care Act (ACA), expanded the scope of these early efforts by including specific legislative provisions supporting transformation initiatives for the delivery system and the Centers for Medicare and Medicaid Services allowed the use of federal stimulus funds to develop information systems necessary for medical home administration.
In the context of these major developments supporting the development and assessment of integrated health systems with the goal of enhancing quality healthcare, several governmental agencies, research groups, and philanthropic foundations initiated proof-of-concept trials of integrated delivery systems for mental and medical healthcare. The Patient-Centered Medical Home (PCMH) model is a key model for integrating healthcare delivery through one main point of access. This review examines the development of integrated care systems into the current concept of PCMH and then describes two basic implementation frameworks: the integration of psychiatric services into a PCMH and the integration of medical services into a Patient-Centered Psychiatric Home (PCPH).
Studies were identified using the following search criteria on Cochrane Review, PsychINFO, and Pubmed: (integrated care) or (collaborative care), and (mental health). The search covered the years 2005–2011. Additional studies were identified manually by reviewing the reference lists of retrieved studies and reviews.
Abstract and Introduction
Abstract
Purpose of review The Patient-Centered Medical Home (PCMH) model is an approach to providing integrated healthcare through one main point of access. As the PCMH model gains increasing adoption in large health systems, its implications for psychiatric services are becoming increasingly important. This review highlights the development of the medical home model and a number of ways in which it has been adopted in psychiatric delivery systems.
Recent findings Numerous pilot initiatives have demonstrated quality improvement through the provision of psychiatric care in medical settings, medical care in psychiatric settings or fully integrated care through broadly trained providers.
Summary The PCMH model offers a useful conceptual framework for the management of complex and chronic psychiatric illness. Early pilots of its use in psychiatric settings have demonstrated that people with psychiatric illness who receive their care in a medical home have better access to care, improved response to treatment, and higher cost-efficiency compared with usual care.
Introduction
Over the past 10 years, the momentum to increase alignment between the clinical, scientific, and administrative infrastructures of the US healthcare system, including mental health services, has been steadily building. In 2001, the Institute of Medicine (IOM) published Crossing the Quality Chasm: A New Health System for the 21st Century. This landmark report sparked a variety of efforts to measure the quality of the healthcare system with the intent to improve health outcomes and reduce preventable errors. In 2003, the President's New Freedom Commission on Mental Health issued Achieving the Promise: Transforming Mental Healthcare in America, which put forth specific recommendations on improving care at the interface between mental health and general medicine. The IOM followed up in 2006 with Improving the Quality of Healthcare for Mental and Substance-Use Conditions, which specified among its recommendations that providers of mental healthcare should increase collaboration between one another and government entities to facilitate the delivery of quality care. Most recently, the March 2010 signing of H.R. 3590, the Patient Protection and Affordable Care Act (ACA), expanded the scope of these early efforts by including specific legislative provisions supporting transformation initiatives for the delivery system and the Centers for Medicare and Medicaid Services allowed the use of federal stimulus funds to develop information systems necessary for medical home administration.
In the context of these major developments supporting the development and assessment of integrated health systems with the goal of enhancing quality healthcare, several governmental agencies, research groups, and philanthropic foundations initiated proof-of-concept trials of integrated delivery systems for mental and medical healthcare. The Patient-Centered Medical Home (PCMH) model is a key model for integrating healthcare delivery through one main point of access. This review examines the development of integrated care systems into the current concept of PCMH and then describes two basic implementation frameworks: the integration of psychiatric services into a PCMH and the integration of medical services into a Patient-Centered Psychiatric Home (PCPH).
Studies were identified using the following search criteria on Cochrane Review, PsychINFO, and Pubmed: (integrated care) or (collaborative care), and (mental health). The search covered the years 2005–2011. Additional studies were identified manually by reviewing the reference lists of retrieved studies and reviews.