The Low-Down on Patient-Centered Primary Care Homes (PCPCHs) by Carrie Baldwin-Sayre, ND | OANP President
You may have heard about a new program in Oregon called the Patient-Centered Primary Care Home Program. Governor Kitzhaber’s goal is to have all Medicaid and Public Employees seen in a PCPCH, and many private insurers are also beginning to require that patients been seen in a PCPCH for all their primary care needs. It definitely seems to be the wave of the future for primary care, and any ND wanting to do primary care needs to start thinking of getting certified as a PCPCH.
And just what is a PCPCH, you ask?
A Patient-Centered Primary Care Home is a health care clinic that has been recognized by the Oregon Health Authority for their commitment to patient-centered care.
Any health care practice that provides comprehensive primary care and meets the key standards can become a recognized Patient-Centered Primary Care Home, including: • Physical health providers (including Naturopathic Doctors, of course!) • Behavioral, addictions and mental health care providers with integrated primary care services • Solo practitioners & group practices • Community mental health centers with integrated primary care services • Rural health clinics • Federally qualified health centers • School-based health centers After the law was passed, I was appointed to the committee that worked to designate what the standards would be for a PCPCH. Soon thereafter, I encouraged the Medical Director of our clinic, Dr. Martin Milner, to seek credentialing as a PCPCH. After explaining to him that the goal of a PCPCH was to provide the best care and coordination of care for patients, he didn't hesitate to start the credentialing process. His clinic, the Center for Natural Medicine in SE Portland, was the first 100% ND clinic to achieve the PCPCH credential. I sat down with Dr. Milner to ask about how it has been for him and the clinic. Here are his thoughts:
Dr. Milner: For years we've been treating complex cardiovascular and chronic conditions, and trying to wean people off their pharmaceutical medications and onto natural therapies. Once 2010 hit (with the expanded ND formulary bill) we were able to take on more primary care patients, and manage all of their medications. Becoming a PCPCH was a natural extension of that, since we were already doing it.
Dr. Baldwin-Sayre: It sounds like you'll be able to serve a much broader population.
Dr. Milner: We're seeing more underserved patients with Medicaid coverage than cash and privately insured patients now. We're seeing people who've never been a part of the healthcare system and haven't had care for many years. We see acute patients more often, and are able to facilitate hospital referrals and bypass the ER due to the relationships we now have with hospitalist groups.
Dr. Baldwin-Sayre: Have you seen any financial benefits from being a PCPCH?
Dr. Milner: Yes. We get paid reasonably well from CareOregon and our patient base has substantially increased. All our doctors are very busy and their schedules are full.
Dr. Baldwin-Sayre: What are some of the challenges you've faced as a PCPCH?
Dr. Milner: Triaging and coordination of care has to be much more sophisticated, managing appropriate referrals, the volume of patients for whom you consider hospitalization increases, and the need to circumvent the ER increases. In general, we're seeing more seriously ill patients that challenge our expertise as primary care naturopathic providers. You have to have the right support staff to pull it off.
Dr. Baldwin-Sayre: Do you believe the PCPCH designation would benefit NDs and the profession as a whole?
Dr. Milner: Yes, definitely. Some have suggested that moving into the primary care realm will take away our naturopathic philosophical and therapeutic focus, but I think it enhances our exposure to the general public because we're now able to manage their medications and transition them to natural therapies when appropriate. We'll reach a much larger audience and more naturopathic doctors can be successful. That being said, it's important that we train NDs who desire this designation and are committed to delivering patient-centered primary care with an integrated model that uses the best of both medical worlds, and train them well.
If you or your clinic is interested in becoming a PCPCH, the best first step is to visit their website at www.primarycarehome.oregon.gov/. There are many resources there to help physicians go through the process. Also, the OANP would love to hear from you if you or your clinic is a designated PCPCH. Please email me at firstname.lastname@example.org.