I try to practice what I preach. That's why I recently switched my health care to a patient-centered medical home team that includes a psychologist. It's only been 13 months, but I already have seen a difference. My care is more psychologically minded and better coordinated, two of the goals that lawmakers foresaw when they included patient-centered medical homes, or PCMHs, as part of the Affordable Care Act.
PCMHs are designed to offer comprehensive, patient-centered care that is coordinated and accessible. Members of PCMH teams are committed to continuous quality improvement and safety. To optimize these improvements in care, psychologists must be leaders. After all, psychologists are the experts in behaviors, a critical priority in this evolving health-care system.
PCMHs date back to 1967 when the American Academy of Pediatrics introduced the term as part of its emphasis on care for children with special needs. In 2008, the National Committee for Quality Assurance (NCQA) recognized the first criteria for PCMHs. This year, NCQA updated its standards to underscore the importance of integrating behavioral and physical health, providing team-based care and improving access to services for high-need populations.
Even more significantly, the American Academy of Family Physicians created the "Joint Principles: Integrating Behavioral Health Care" to ensure that behavioral health is central to the PCMH model. This document offers a complementary set of joint principles to the original document. APA was the first mental health organization to endorse these complementary principles.
Psychologists can and should play major roles in ensuring that these criteria are met, for several reasons. Research shows that most patients seen by primary-care physicians have high rates of behavioral health problems. Studies also show that when behavioral health needs are met in PCMHs, patients have better health outcomes and are more satisfied with their care. In addition, the enhanced care psychologists provide actually lowers costs.
What roles do psychologists play in PCMHs? To name just a few, psychologists take the lead in outcomes assessment and improve and oversee screening systems. They facilitate effective functioning among the patient, the health-care team and the family. They offer evidence-based interventions and develop and disseminate treatment protocols for comorbid physical and behavioral health problems.
Excellent examples of psychologists working within the PCMH model are seen in the Department of Veterans Affairs Patient Aligned Care Teams (PACT) primary-care clinics. Other examples of psychologists' work in PCMHs appear in articles beginning with "Psychology's roles in patient-centered medical homes."
To maximize the potential of psychologists as members of PCMHs, we must act swiftly. Practitioners can partner with colleagues from other professions and organizations, be seated at the critical local and national tables to ensure full inclusion of behavioral health care, be mindful of the ethics in caring for patients as part of an interdisciplinary team, and assume leadership positions.
Researchers can collaborate in research that examines the effectiveness and efficiency of PCMHs and study the unique value added by psychologists.
Educators must ensure that accreditation standards require training in the requisite competencies, such as interprofessional collaborative care, Health Service Psychology Education Collaborative competencies, and Competencies for Psychology Practice in Primary Care. Educators must also make certain that didactic and experiential training is sufficient and continually updated for trainees and professionals alike, obtain appropriate training themselves, and seek relevant board certification.
Psychologist advocates must shape the future by ensuring that behavioral health is prioritized in all PCMHs. They must also recommend an alternate to the physician as a team lead, with a focus instead on patient-centered collaborative care or health care or clinician directed team-based care. Advocates must also support more family-centered care.
As Susan H. McDaniel, PhD, and Colleen T. Fogarty, MD, asserted in their 2009 article in Professional Psychology: Research and Practice, psychologists give meaning to the word "home" in the PCMH model.
