Miller Benjamin F, Ross Kaile M, Davis Melinda M, Melek Stephen P, Kathol Roger, Gordon Patrick
Eugene S. Farley, Jr. Health Policy Center, University of Colorado School of Medicine.
Department of Family Medicine, Oregon Health and Sciences University.
Am Psychol. 2017 Jan;72(1):55-68. doi: 10.1037/a0040448.
The patient-centered medical home (PCMH) is a promising framework for the redesign of primary care and more recently specialty care. As defined by the Agency for Healthcare Research and Quality, the PCMH framework has 5 attributes: comprehensive care, patient-centered care, coordinated care, accessible services, and quality and safety. Evidence increasingly demonstrates that for the PCMH to best achieve the Triple Aim (improved outcomes, decreased cost, and enhanced patient experience), treatment for behavioral health (including mental health, substance use, and life stressors) must be integrated as a central tenet. However, challenges to implementing the PCMH framework are compounded for real-world practitioners because payment reform rarely happens concurrently. Nowhere is this more evident than in attempts to integrate behavioral health clinicians into primary care. As behavioral health clinicians find opportunities to work in integrated settings, a comprehensive understanding of payment models is integral to the dialogue. This article describes alternatives to the traditional fee for service (FFS) model, including modified FFS, pay for performance, bundled payments, and global payments (i.e., capitation). We suggest that global payment structures provide the best fit to enable and sustain integrated behavioral health clinicians in ways that align with the Triple Aim. Finally, we present recommendations that offer specific, actionable steps to achieve payment reform, complement PCMH, and support integration efforts through policy. (PsycINFO Database Record
以患者为中心的医疗之家（PCMH）是重新设计初级保健以及最近专科保健的一个很有前景的框架。根据医疗保健研究与质量局的定义，PCMH框架有五个属性：全面护理、以患者为中心的护理、协调护理、可及服务以及质量与安全。越来越多的证据表明，为了让PCMH最好地实现三重目标（改善结果、降低成本和提升患者体验），行为健康（包括心理健康、物质使用和生活压力源）的治疗必须作为核心原则加以整合。然而，对于现实世界中的从业者来说，实施PCMH框架的挑战因支付改革很少同时进行而更加复杂。这一点在将行为健康临床医生整合到初级保健的尝试中最为明显。随着行为健康临床医生找到在整合环境中工作的机会，对支付模式的全面理解对于对话至关重要。本文描述了传统按服务收费（FFS）模式的替代方案，包括改良FFS、按绩效付费、捆绑支付和全球支付（即人头费）。我们认为，全球支付结构最适合以与三重目标相一致的方式启用和维持整合的行为健康临床医生。最后，我们提出了一些建议，提供了实现支付改革、补充PCMH并通过政策支持整合努力的具体、可操作步骤。（PsycINFO数据库记录）
