WASHINGTON (Army News Service, Oct. 17, 2011) -- The Army Medical Command is working to improve care by focusing on creating clinics based on small-group family practices.

The goal is to apply the Army Patient Centered Medical Home model to all treatment facilities throughout the Army, said Col. Mark Reeves, a family practice specialist with MEDCOM who spoke at the Association of the U.S. Army Annual Meeting and Exposition, Oct. 11.

"We are pushing the whole process hard and are making progress," he said.

Patient Centered Medical Home is part of the Army medical system's transformation. It focuses on the small family practice and starts with the patient. Each primary care manager, or PCM, has two licensed practical nurses that work together all the time to form a core team.

The aim of the core team is to develop a long-term relationship with patients. No more than five of these core teams make up a patient center medical home, creating a small group practice.

"We have come to realize that we cannot achieve 100 percent continuity with one PCM with all the patients they have to manage all of the time," Reeves said. "The next-level effort is to have a small available group practice that prioritizes knowing that group of patients very well and cross coverage is seamless."

Included in the medical home model is a behavioral health specialist, a dietician and a clinical pharmacist.

"These three skill sets represent well the overall incidents of what our patients conditions are and these are some areas that patients have said they've had difficulty accessing," Reeves said. "Aligning these three specialties with the primary care workforce is likely to achieve significant synergy that helps our patients get what they need with limited barriers."

Throughout this model is case management for the more complex patients and care coordination for every single patient.

As the medical homes are created, one of the short-term goals, which will be a long-term indicator of success, is National Committee of Quality Assurance recognition for the medical homes. The NCQA measures the ability of facilities to provide quality healthcare through standardized, objective measurement guidelines.

The guidelines, called the Healthcare Effectiveness Data and Information Set, have been broadly adopted throughout the American medical community. HEDIS includes performance measures related to dozens of important health-care issues. Selected measures include: advising smokers to quit; antidepressant medication management; breast cancer screening; cervical cancer screening; children and adolescent access to primary-care physicians; children and adolescent immunization status; comprehensive diabetes care; controlling high blood pressure, and prenatal and postpartum care.

Patients regularly receive surveys in the mail from medical treatment facilities to gauge the effectiveness and quality of the care they received. Satisfaction surveys from the past year indicated that 95 percent of people were happy when they saw their primary-care manager. Nearly 93 percent of the people surveyed were satisfied with their primary-care manager.

"Patients are much happier if they see their PCMs because this is somebody that they develop a long-term relationship with who knows their health history and is thinking toward their benefit," Reeves said.

The overall satisfaction with the system was 91 percent, which implies that there are system issues. Reeves said some were probably driven by lack of access, others driven by the absence of care coordination, and perhaps a lack of a multidisciplinary team.

"Bottom line is if you see a PCM you like and trust, you are more likely to be interested in doing the things that team develops and you are more likely to be inclined to health maintenance and readiness," Reeves said.