A growing amount of research shows that patient-centered medical homes lower health-care costs and improve patient care — two reasons why both APA and the Affordable Care Act have embraced patient-centered homes and are promoting them to health system administrators and psychologists nationwide.
Patient-centered medical homes, or PCMHs, represent a transition away from a model of symptom- and illness-based episodic care to a more patient-centered, comprehensive, team-based, coordinated, accessible system of care focused on quality and safety.
PCMHs seek to provide each patient with an ongoing, active partnership with a personal primary-care physician and a team of professionals, often including psychologists or other behavioral health providers. They provide proactive, preventive and chronic care management through all stages of life. PCMH care is coordinated with all providers through the use of health information technologies.
To explore and convey to other psychologists, health-care providers, and the public the vital role psychologists can and do play in PCMHs, APA President Nadine J. Kaslow, PhD, has established a task force. Co-chaired by Anne Kazak, PhD, and Kimberly Hiroto, PhD, the group is evaluating data on how psychologists in these systems of care are enhancing patients' and families' behavioral and physical health outcomes.
"Mental health services are not consistently present in primary-care settings, despite the number of patients presenting to their physician with comorbid mental health problems such as depression, substance abuse and anxiety," says Hiroto, a geropsychologist in the Home-Based Primary Care Service at the American Lake Division of the Puget Sound VA Health Care System, in Tacoma, Washington.
Psychologists play a critical role in the PCMH, she says, by attending to patients' often unmet psychological and behavioral needs. "The PCMH approach results in fewer primary-care and hospital visits, improved patient functioning, and reduced costs, and it allows the team to reduce its workload by decreasing the number of repeat visits by patients and to feel more satisfied with their work."
The APA task force is developing online tools for providers about the PCMH and integrated care. In addition, the group will develop resources to inform the general public about psychologists' roles on these teams, as well as a series of papers related to the PCMH concept and the role of psychologists. And the task force is looking at training gaps for psychologists who want to work in PCMHs.
"We really don't have enough training programs right now to prepare psychologists for what it's like to work in primary-care medicine," says Patricia Areán, PhD, psychology professor at the University of California, San Francisco. "It's actually a very specialized set of skills."
Improving care
One of the latest studies to confirm the promise of PCMHs was published online in July in Health Services Research. In this study, the researchers looked at Medicare claims filed over three years by 308 PCMHs and compared them with claims from nearly 2,000 primary-care practices in the same ZIP codes.
The researchers found that the PCMH practices had a 6 percent decline in emergency room visits. Zooming in to examine patients with multiple chronic illnesses, the researchers found even greater differences, with the PCMH practices showing a 4 percent reduction in hospitalizations and a 10 percent reduction in emergency room visits compared with the control group.
"Patient-centered medical homes provide better access to care, and this study is showing that this has a bigger effect when patients are sicker," says Sarah H. Scholle, DrPH, vice president of research and analysis at the National Committee for Quality Assurance (NCQA), a nonprofit organization dedicated to improving health-care quality.
All of the PCMH practices in the study had been recognized by NCQA as adhering to a model of care that combines teamwork and information technology to improve care, enhance patients' experience of care and reduce costs. Many insurers pay higher reimbursement rates to practices that have earned the NCQA-PCMH seal.
The good news for psychologists and other behavioral health professionals is that this year, NCQA is expanding its behavioral health integration requirements. Now, any practice that wants to acquire NCQA-PCMH recognition is expected to collaborate with behavioral health care providers and to communicate the availability of behavioral health care to patients. (For more information on the NCQA-PCMH seal, visit NCQAopens in new window and look under the "programs" tab.)
A key component of PCMHs is helping patients set their own health goals and self-management of health, says Parinda Khatri, PhD, chief clinical officer at Cherokee Health Systems, a community health care organization with 56 clinics in Tennessee.
Khatri, also a member of the APA task force, says Cherokee Health Systems earned NCQA-PCMH Recognition in 2012, partly due to the organization's focus on helping patients better manage their chronic health conditions.
"The management of chronic health conditions places such a demand on the patient to make lots of behavioral health changes," Khatri says. "Psychologists know a lot about how to work with people to help them change behaviors in an effort to optimize their health status."
Opening doors
Helping to optimize patient care is just one of several opportunities psychologists see in the move toward PCMHs. In addition to providing psychosocial interventions for patients, psychologists can design and lead patient-centered care programs — on smoking cessation or diabetes management, for example — evaluate systems, provide mental and behavioral health consultations and measure quality-improvement outcomes, says clinical psychologist Joan Asarnow, PhD, another task force member.
"It's what we do best as psychologists — evaluating whether interventions work, and when we find interventions that work, we try to disseminate them into the world," Asarnow says.
Psychologists' training also prepares them to build teams, a skill that's increasingly necessary as team-based care continues to become more widespread, says Cheyenne Hughes-Reid, PhD, a pediatric psychologist with Nemours/Alfred I. duPont Hospital for Children in Wilmington, Delaware (see Leading the Charge article).
In fact, she says, psychologists' training in decision-making and systems change are essential to moving toward the PCMH model. "We can provide some really good resources to patients and be of great support to our medical colleagues about how to make this happen and make it sustainable."
Amy Novotney is a journalist in Chicago.