The landmark Healthy People report is a baseline for health educators, community planners, clinicians, and other stakeholders. The information in the report establishes support for external funding opportunities and facilitates the assessment of national health outcomes. The Healthy People 2010 analysis revealed areas that require further monitoring and improvement, such as mental health diagnosis and treatment, obesity and physical activity, tobacco use in adolescents, and HIV/AIDS in females.1 These deficiencies were reflected in Healthy People 2020 (HP2020), which demonstrated a renewed emphasis on eliminating health disparities and facilitating health promotion.2
One potential method to successfully address the HP2020 objectives is the patient-centered medical home (PCMH). This care model focuses on two tenets, both of which are aligned with HP2020: enhanced access to care and improved care at a decreased cost.3 PAs facilitate access to cost-effective care in a variety of settings, and in January 2011, the National Committee for Quality Assurance (NCQA) recognized PA-led medical homes as eligible for recognition.4 This revamped and expanded model of the PCMH may provide health care delivery in order to positively impact the outcomes of Healthy People 2020.
The PCMH is a model of health care delivery that is closely aligned with the goals of Healthy People. The core principles include patient-centered care, primary care, and payment reform.3 These principles ideally address the core focus areas in HP2020, with an emphasis on access to, and utilization of, health prevention services. Pilot projects are under way, and while preliminary data are promising, most evaluation data are pending.5,6
Studies demonstrate that patients without a usual source of care suffer poor health outcomes.6 However, medical students are selecting specialty practice instead of primary care because of multiple economic, personal, and workforce factors.3 PAs mirror this trend, but the largest cohort of PAs (36%) remains in primary care, which may have contributed to the revised model of care that includes PA-managed medical homes.7,8 Regardless, stakeholders in medical education and health services funding agencies may become more involved in the recruitment and retention of primary care providers. The data support that morbidity and mortality improve in patients with a primary care provider. There also seems to be an inverse correlation between having primary care access and disparities for at-risk populations, hospitalization rates, and total costs of health care.6,9
In the medical home, the traditional hierarchical model of care is modified to that of a collaborative, patient-centered model.3 This philosophical shift requires widespread cultural and educational modification in the practice of medicine. Patients are dissatisfied with the existing structure, including the lack of coordinated care, poorly organized medical records, and inability to locate accurate health care information.6 Yet the collaborative model is a familiar one to PAs, who are well-positioned to facilitate positive change in primary care.
The economic disparities between specialists and generalists, fragmented health care delivery, and system- and procedure-driven payment processes may be addressed through the PCMH.3 Furthermore, US health care expenditures continue to rise disproportionate to economic gains, and almost 50 million people remain uninsured,5 which highlights the need for some type of modified system. Yet buy-in from physicians and health care providers remains limited because of logistical and financial challenges.3
Preliminary data indicate that primary care providers using the medical home model demonstrated reductions in patient hospitalization, use of emergency care, and overall health care costs.6 Yet, with a project of this scope and potential impact, major evaluation criteria need to be further identified and analyzed. In addition to patient outcomes, the impact of external factors (such as recruitment and retention of primary care providers), identification and evaluation of quality indicators, and sustainability of the model are only a few major criteria identified in the literature.3,5,6,9,10 Nonetheless, a revamped primary care structure that includes a partnership with PAs has potential to positively impact health care delivery, access to care, and patient outcomes. JAAPA
Alison Essary is an associate professor and interim program director,
Midwestern University PA program, Glendale, Arizona, and the chair of CSAC, the Clinical and Scientific Affairs Council of the AAPA.
REFERENCES
1. US Department of Health and Human Services. Healthy People 2010: Understanding and Improving Health. 2nd ed. Washington DC: US Government Printing Office; November 2000.
2. US Department of Health and Human Services. Healthy People 2020. http://www.healthypeople.gov/2020/default.aspx. Accessed March 8, 2011.
3. Rittenhouse DR, Shortell SM. The patient-centered medical home: will it stand the test of health reform? JAMA. 2009;301:2038-2040.
4. National Committee for Quality Assurance. The 2011 PCMH standards and guidelines. http://www.ncqa.org/. Accessed March 8, 2011.
5. Barr MS. The need to test the patient-centered medical home. JAMA. 2008;300:834-835.
6. Kirk LM. The patient-centered medical home: a "new" model for health care. Presented at: Internal Medicine Grand Rounds, the University of Texas Southwestern Medical Center at Dallas. January 9, 2009.
7. Essary AC, O'Donoghue DL, Boissonneault GA, et al. The patient-centered medical home: a model for primary care [Clinical Watch]. JAAPA. 2009;22(9):16-21.
8. American Academy of Physician Assistants National Physician Assistant Census Report. Results from AAPAs 2009 Census. http://www.aapa.org/images/stories/Data_2009/National_Final_with_Graphics.pdf. Accessed March 8, 2011.
9. Grumbach K, Bodenheimer T. A primary care home for Americans: putting the house in order. JAMA. 2002;288:889-893.
10. Bodenheimer T, Grumbach K, Berenson RA. A lifeline for primary care. N Engl J Med. 2009;
360(26):2693-2696.