This advisory is another posting in a series discussing various aspects of the recently enacted Massachusetts health care reform legislation, Chapter 224 of the Acts of 2012 (the “Act”). The Act contains a number of elements that, taken together, are expected to have a positive impact on slowing the rate of increase in health care costs in the Commonwealth. An earlier alert discussed the mechanism of benchmarking total health care expenditures and implementing steps to address how providers, provider organizations, and carriers would stay within the benchmarks. This advisory describes the Act’s promotion of Patient Centered Medical Homes (PCMH) as a model for improving the continuity and quality of care and perhaps the cost of care as well.

Background -

PCMHs take a holistic approach to health care for their patients. PCMHs look to unite primary and specialty care, as well as institutional care, in a “medical home” under the guidance of primary care providers (PCPs). The members of the “health team” communicate with each other to more efficiently serve the needs of patients. Additionally, as PCP-centered operations, PCMHs focus on managing and preventing chronic diseases and disorders, such as diabetes or obesity, with the belief that addressing these situations earlier necessarily prevents later, more expensive hospitalizations or emergency room visits. By utilizing health information technology (IT) to track and monitor patients, PCPs can collect, interpret, and organize data about their patients, which enables them to prescribe and conduct proactive measures to limit the damage of chronic illness or prevent conditions like diabetes from even developing. PCMHs are seen as shifting the responsibility for the patient back to the PCP, who can develop a deeper relationship with the patient through enhanced communication, which in turn entices the patient to take a greater role in the self-care and self-management of his or her ailments (hence the term “patient centered”).