The 1st section is a summary of the history behind and principles of the PCMH along with a description of the NCQA’s recognition standards. It notes that the recognition may fall short of addressing behavioral, care coordination, multidisciplinary and shared decision making dimensions of the PCMH and hints recognition standards will be revised, including a public comment period ‘scheduled for 2009.’
The second section discusses why purchasers should support the PCMH: quality isn’t good, purchasers have a stake in employer-based insurance and primary care is in decline. ‘But for’ better access to turbo-charged primary care, quality would soar and costs would decline. What’s more, increased numbers of young physicians would pursue a career in primary care.
The 3rd section describes strategies on how the PCMH agenda can be advanced including convincing your regional insurer to participate in a PCMH ‘pilot,’ asking about support for some or all elements of it in Requests For Information or Proposals (RFIs or RFPs), offering to pay for it, educating local stakeholders, incenting employees and seeking inclusion of the PCMH in any carve outs.
The 4th section has Case Studies. This is followed by Appendices that include a description of the NCQA standards, suggested contract language, an RFI template and a description of pilots currently underway.
This is must reading if you’re interested in the PCMH. The Disease Management Care Blog also salutes the authors for doing a good job of being complete as well as honest. This is a well-referenced document that not only includes information on how elements of the PCMH have succeeded, but how they sometimes have fallen short on reducing health care costs and how much of the information is still preliminary. The marketing side of disease management industry has something to learn here.