Promoting cancer screening within the patient centered medical home

Authors


  • We would like to acknowledge the National Colorectal Cancer Roundtable for convening a meeting in September 2010 on integrating cancer screening into the patient centered medical home, and the panel of experts from around the country who attended the meeting and contributed to the ideas expressed in this article.

  • DISCLOSURES: This work was supported by Centers for Disease Control and Prevention (CDC) Cooperative Agreement No. U50/DP001863. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the CDC.

Abstract

While consensus has grown that primary care is the essential access point in a high-performing health care system, the current model of primary care underperforms in both chronic disease management and prevention. The Patient Centered Medical Home model (PCMH) is at the center of efforts to reinvent primary care practice, and is regarded as the most promising approach to addressing the burden of chronic disease, improving health outcomes, and reducing health spending. However, the potential for the medical home to improve the delivery of cancer screening (and preventive services in general) has received limited attention in both conceptualization and practice. Medical home demonstrations to date have included few evidence-based preventive services in their outcome measures, and few have evaluated the effect of different payment models. Decreasing use of hospitals and emergency rooms and an emphasis on improving chronic care represent improvements in effective delivery of healthcare, but leave opportunities for reducing the burden of cancer untouched. Data confirm that what does or does not happen in the primary care setting has a substantial impact on cancer outcomes. Insofar as cancer is the leading cause of death before age 80, the PCMH model must prioritize adherence to cancer screening according to recommended guidelines, and systems, financial incentives, and reimbursements must be aligned to achieve that goal. This article explores capacities that are needed in the medical home model to facilitate the integration of cancer screening and other preventive services. These capacities include improved patient access and communication, health risk assessments, periodic preventive health exams, use of registries that store cancer risk information and screening history, ability to track and follow up on tests and referrals, feedback on performance, and payment models that reward cancer screening. CA Cancer J Clin 2011. © 2011 American Cancer Society.

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