Tuesday, December 11, 2012
As parents, friends and advocates of young children, most of us are aware of the importance of high-quality health care and access to health care in children’s lives. With health care reform, the topic of health care has come to the forefront of the national psyche and local conversations in the past three or four years.
The Patient Protection and Affordable Care Act of 2010 included reforms that affect young children and their health care. Most Americans are aware of the more publicized reforms such as the changes in how pre-existing conditions are treated by insurance companies.
However, there are more complex reforms within the law that are just starting to affect young children, including pilot programs to support medical practices that create patient-centered medical homes.
What is the difference between a standard health care practice and a PCMH? Many pediatrician and primary care offices already have created environments that would be considered a PCMH.
The change is that there now are specific standards regarding PCMH status. Various agencies across the country offer medical practices recognition as PCMHs through a standardization and certification process. As practices receive this recognition and follow its standards, they will receive increased reimbursement for medical claims from insurances and, in some cases, eventually will receive decreased reimbursements if they do not pass certain standards.
Some advantages for users of health care who are receiving care from a PCMH are:
■ Your provider will know your child and begin to learn his or her history throughout time, developing a sense of trust between you and the provider.
■ Your child’s medical records will be organized in one location, allowing you and the provider to access important records about referrals, immunizations and your child’s care at locations outside that medical home, such as a visit with a specialist. This allows your provider to coordinate your care among the providers your child may need to see throughout his or her lifetime.
■ A PCMH practice provides comprehensive services that look at the entire picture of health. PCMH practices provide ways to contact providers after hours, assess your child’s lifestyle factors and how they influence health, and include behavioral or emotional health in assessing your child’s overall health care needs
As these health care reforms begin to take shape, we as users of health care also will have increased responsibility in taking care of our health and the health of our children. Some of those increased responsibilities include following specific health and lifestyle plans created by our medical providers regarding chronic conditions such as asthma and diabetes, taking our children to recommended wellness and immunization visits and contacting our medical providers for care in nonemergency situations versus using the more costly emergency room.
These and many other changes in the health care system are taking shape in Colorado and across the country, with states and individual medical practices making their own decisions on how to implement the changes within their organizations.
If you would like to know more about a clinic’s PCMH status, ask your child’s provider or visit www.coloradomedicalhome.org.
Summer Laws has a Master of Public Health and is a performance improvement specialist with the Northwest Colorado Visiting Nurse Association.