Health Management Organization and Workforce Coursework

Difference between PCMH and HMO

The patient-centred medical home model (PCMH) in essence can be described as an enhanced form of primary care delivery wherein it attempts to implement:

1. Better Access to medical care for patients
2. Better coordination of medical care on the part of doctors and medical personnel
3. Prevent adverse medical practices (i.e. unnecessary procedures)
4. Create a better system of quality and patient safety
5. To promote a stronger and better partnership between a patient and his or her primary care physician.

The PCMH model does this by ensuring that patients can choose the type of doctor they deal with (i.e. in cases where specialists are needed), the type of procedures they undergo and in essence does not act as a “gatekeeper” as seen in the case of HMOs wherein patients have to go through their primary care physician and get a referral before they are allowed to go to a specialist for their case (Henschen et al., 2013). From this, it can be seen that PCMH focuses more on giving patients the capacity to choose and make them feel more comfortable with medical care as opposed to feeling like they are being scrutinized daily.

On the other end of the spectrum, a health management organization (HMO) is similar to a PCMH in that it manages care for patients who have health insurance through individual benefit plans or organization based health care benefits packages. Such a service acts on a prepaid basis wherein patients can come in for a variety of medical concerns (Klein et al., 2013). The problem with HMOs at present though is that provision of service is often very limited with the patients having little choice in terms of the type of specialists they are referred to via their primary health care physician (Klein et al., 2013). Furthermore, the contractual nature of HMOs and the fact that there are no set salaries for doctors often results in a practice wherein unnecessary procedures an examinations are conducted even if the patient at times objects to inflate the bill given to the health insurance company.

Workforce Development

What must be understood is that the success of any medical organization are dependent upon the type of technical teams that are the backbone of the company wherein through the utilization of a variety of management practices a seamless integration of vertical and horizontal means of collaboration need to be implemented to create a stable organizational structure for proper operations and the provision of care to patients. As such, by developing the workforce through training programs, seminars and sponsored medical lessons, a medical organization can increase the quality of care that it can provide to its patients. Berryman et al. (2013) back up this statement by explaining that all too often one of the main reasons behind poor patient care standards within hospitals is a result of a lack of sufficient training and experience among the personnel to deal with a myriad of patient issues. Through the development of personnel, the patient-centred medical home process is better able to deal with a wider variety of possible concerns resulting in a more effective and efficient process without having to refer the patient to outside organizations due to a lack of internal experience and ability.

Payment Reform

Through the analysis of Alexander et al. (2013), it was seen that the problem with the payment structure of HMOs at present is that it encourages doctors to subject patients through a gamut of expensive and at times harmful procedures to increase the amount of money they get through the patient’s medical insurance. These unnecessary tests create problems not only for the patient but for the medical industry itself, given the increases associated with patient care. By implementing payment reform through a standardized salary system for doctors and healthcare workers regardless of the number of patients or type of procedure that was implemented, this encourages proper patient care. Since the Patient-Centered Medical Home process focuses on a systems-based approach to quality and safety, a payment system that prevents unnecessary testing procedures that could have adverse consequences or even delayed care will result in a process that the patient-centred medical home process (PCMH) focuses on provisioning. It cannot be stated that the PCMH process is a success if patients are subjected to unnecessary procedures merely for the sake of increasing the salary received by medical personnel. By taking the issue of “salary” off the table, doctors are better able to focus on what matters, namely properly taking care of their patients.

Health IT

Health information systems can be described as the interface between people, organizations, and technology, enabling the business to accomplish a specific task or action. What must be understood is that information systems act as methods of integration for a company helping to streamline specific processes so that they can be controlled, influenced and improved when necessary (Henschen et al., 2013). In other words, information systems can be classified as solutions to identified problems or necessary methods of integration. In the case of PCMH, this means making easier for patients to choose the doctor they need, the type of care they want, as well as makes it more convenient to be able to see results and schedule appointments through an online information portal (Henschen et al., 2013). Through such services, this makes the process of provisioning medical care that much more convenient, easier and effective for patients which PCMH is all about.

Reference List

Alexander, J. A., Paustian, M., Wise, C. G., Green, L. A., Fetters, M. D., Mason, M., & El Reda, D. K. (2013). Assessment and Measurement of Patient-Centered Medical Home Implementation: The BCBSM Experience. Annals Of Family Medicine, 11(Supp 1), S74-S81.

Berryman, S. N., Palmer, S. P., Kohl, J. E., & Parham, J. S. (2013). Medical Home Model of Patient-Centered Health Care. MEDSURG Nursing, 22(3), 166-196.

Henschen, B., Garcia, P., Jacobson, B., Ryan, E., Woods, D., Wayne, D., & Evans, D. (2013). The Patient Centered Medical Home as Curricular Model: Perceived Impact of the ‘Education-Centered Medical Home’. JGIM: Journal Of General Internal Medicine, 28(8), 1105-1109.

Klein, D. B., Laugesen, M. J., & Liu, N. (2013). The Patient-Centered Medical Home: A Future Standard for American Health Care?. Public Administration Review, 73S82-S92.