- Introduction: A Top-Level Look at the Future of Federal Medicine
- Military Health System in Time of Transition as Conflicts End
- Army Medicine: Redefining Its Role in the Generation of a Ready and Resilient Force
- Air Force Medicine: Averting an Identity Crisis
- Moving Forward with Reforming the Indian Health Service
- The Clinical Pharmacy Specialist's Growing Provider Role in VA
- Public Health Service Pharmacy: Accelerating Transformation
- Military Pain Management’s Future: Less Invasive, More Data-Driven Techniques
- Navy Medicine: Strong, Agile and Ready
- Telemental Health in VA: A New Source of Support for Veterans
Patient-Centered Medical Home/Soldier-Centered Medical Home
Transformation of Army primary care to the Patient-Centered Medical Home (PCMH) care delivery model is a key driver of our broader transformation to a system for health. Of 144 primary-care practices in the Army, 66 have already earned recognition as Patient-Centered Medical Homes by the National Committee for Quality Assurance (NCQA). Those practices provide care for 645,000 soldiers, family members and retirees — a full 47% of our enrolled beneficiaries.
But those numbers don’t begin to describe how PCMH drives value at all levels of Army Medicine. Focus first on our commitment to designing and delivering a consistently competitive patient experience. Because primary care is the portal to Army Healthcare, we are in the process of re-engineering the patient “on-boarding” process to make it as easy and positive as possible. That means more engaging, user-friendly websites and printed material that make it easy to access and use healthcare while shaping better healthcare consumption behaviors. Improving the on-boarding process also means an easier, more flexible enrollment and empanelment process and proactively introducing the patient to the care team and vice versa.
PCMH is the catalyst for improvement in the range of access options to better meet patient needs and preferences. For too long, we have relied on a model of care delivery built around the face-to-face visits with the patient’s primary-care clinician. We have now greatly expanded the range of access options to include group visits, virtual visits using Army Medicine Secure Messaging Service and direct and telehealth links to clinical pharmacists, dieticians and other members of the expanded primary-care delivery team.
That care team is the key to Army Medicine. Every patient has a primary-care manager who works with a core group of nurses and other healthcare providers using population and individual health data to provide comprehensive care focused on prevention, disease management and health and wellness. As the patient’s needs change, the composition of the care team also changes, augmented with nurse case managers, behavioral health providers, clinical pharmacists, dieticians and others, as necessary. Every member of that team, from front-desk staff to medic to physician is empowered to identify and responsibly reconcile safety and customer-service problems on the spot. Perhaps most importantly, the patient also is on the team — educated and motivated to grow from passive recipient to active participant in their care.
That active participation is essential to our ability to more effectively influence the choices patients make in the LifeSpace — that 525,500 minutes a year when patients are at home, work or play. Most decisions that affect health are made in the LifeSpace, and the PCMH is designed to maximize our effectiveness in shaping the LifeSpace to generate health. Health generation is underwritten by Army Medicine’s Performance Triad of sleep, activity and nutrition. Taken together, these factors have an enormous impact on health and wellness. Sleep, activity and nutrition influence important chronic diseases such as diabetes, heart disease and mental illness, while shaping the risk of developing disease and disability. The PCMH is a platform from which we influence the Performance Triad in the LifeSpace. That influence starts with simple steps, such as assessing each patient along the Performance Triad, training staff to provide health coaching focused on the Performance Triad and building patient awareness and empowerment through the use of technology that reaches into the LifeSpace.
Army Patient-Centered Medical Home is clearly more than a care-delivery site; it is a health-delivery platform upon which we build a more comprehensive, coordinated and effective system for health. The LifeSpace and Performance Triad are extensions of that platform. Equally important is the role that PCMH has in integrating care across the spectrum of Army Medicine.
In many ways, the structure of healthcare-delivery systems like Army Medicine has reflected the structure of the labor force and payment systems. Those structures, whether professional (physicians, nurses, administrators) or economic (outpatient, ambulatory, impatient, emergency) have shaped the way that we interact with patients. The result, from the patient perspective, is a system marked by redundancy, lack of coordination and unwarranted risk.
As we deploy the Army PCMH model, we are engineering standard processes that redesign and reconnect each piece of Army Medicine so that the patient’s care experience is safe, seamless and health-generating. The depth and breadth of PCMH-driven change is truly breathtaking. The change-management process can be complex and difficult. Patient-centered care is a culture, not a campaign. The true motivator is the sure knowledge that, at the end of the day, the care we deliver to your family or to mine will be safer, more satisfying and life-enhancing.