At its November 2008 planning session, the Board of Trustees of the American Association of Medical Assistants (AAMA) directed AAMA Executive Director and Legal Counsel Donald A. Balasa, JD, MBA, to represent the AAMA at the December 2008 Conference on Practice Improvement: Blueprint for the Medical Home, sponsored by the American Academy of Family Physicians and the Society of Teachers of Family Medicine. The meeting focused on providing resources and sharing experiences about how primary care medical practices can incorporate elements of the Patient-Centered Medical Home (PCMH) model into the delivery of care. What follows is Executive Director Balasa’s report.

The Patient-Centered Medical Home

In 2007 the American Academy of Family Physicians (AAFP), the American Academy of Pediatrics (AAP), the American College of Physicians (ACP), and the American Osteopathic Association (AOA)—representing approximately 333,000 physicians—issued Joint Principles of the Patient-Centered Medical Home (Joint Principles).1 This document defined the Patient-Centered Medical Home (PCMH) as follows:

The Patient-Centered Medical Home (PCMH) is an approach to providing comprehensive primary care for children, youth, and adults. The PCMH is a health care setting that facilitates partnerships between individual patients, and their personal physicians, and when appropriate, the patient’s family.

The following are the seven principles agreed to by the AAFP, AAP, ACP, and AOA to describe the characteristics of the PCMH:

1. Personal physician

2. Physician directed medical practice

3. Whole person orientation

4. Care is coordinated and/or integrated

5. Quality and safety

6. Enhanced access

7. Payment reform

Linchpins of the PCMH

During the Conference on Practice Improvement it became apparent that CMAs (AAMA) are vital and important allied health professionals that will be needed for the successful implementation of the PCMH approach to primary care. Indeed, the 2008 Core Curriculum for Medical Assistants, published by the Medical Assisting Education Review Board (MAERB), offers elements ideally targeted to prepare medical assisting students for crucial roles in the PCMH. The 2008 Core Curriculum is appended to the 2008 Standards and Guidelines for the Accreditation of Educational Programs in Medical Assisting, published by Commission on Accreditation of Allied Health Education Programs (CAAHEP).2

Essential Joint Principles and educational elements

Five of the seven joint principles are particularly relevant to the role of the CMA (AAMA) and are supported by the 2008 Core Curriculum for Medical Assistants:

1. Physician directed medical practice—the personal physician leads a team of individuals at the practice level who collectively take responsibility for the ongoing care of patients.

As reflected in this principle, all members of the primary health care team—not just the physicians—are responsible for the care and well-being of all patients. The following element of the 2008 Core Curriculum prepares a CMA (AAMA) for this important responsibility: Apply critical thinking skills in performing patient assessment and care. For a CMA (AAMA), care of patients is not just performing tasks assigned by the supervising or delegating physician. Rather, by necessity, patient-centered care requires the CMA (AAMA) to exercise critical thinking skills and refer appropriate information pertaining to issues worthy of special attention to the physician and other care team members.

2. Whole person orientation—the personal physician is responsible for providing for all the patient’s health care needs or taking responsibility for appropriately arranging care with other qualified professionals. This includes care for all states of life; acute care; chronic care; preventive services; and end-of-life care.

The PCMH philosophy does not end when the patient leaves the delivery setting. The primary care provider and the provider’s “teammates” must be able to immediately and seamlessly arrange ancillary care with other professionals (e.g., social workers, counselors, and physical therapists). The role of the CMA (AAMA) is central for making this “whole person orientation” a reality. Note the following Core Curriculum element: Develop and maintain a current list of community resources related to patients’ health care needs.

3. Care is coordinated and/or integrated across all elements of the complex health care system (e.g., subspecialty care, hospitals, home health agencies, and nursing homes) and the patient’s community (e.g., family, and public and private community-based services). Care is facilitated by registries, information technology, health information exchange and other means to ensure that patients get the indicated care when and where they need and want it in a culturally and linguistically appropriate manner.

The health care system is indeed complex. Information technology is a useful means for assuring that patients “get the indicated care when and where they need and want it.” However, “electronically-facilitated” information can lose most or all of its value if it is not communicated to the patient “in a culturally and linguistically appropriate manner.” The following Core Curriculum elements demonstrate the expertise of CMAs (AAMA) for communicating in appropriate and understandable ways:

  Use language/verbal skills that enable patients’ understanding.

  Demonstrate respect for diversity in approaching patients and families.

  Demonstrate empathy in communicating with patients, family, and staff.

  Apply active listening skills.

 Demonstrate respect for individual diversity, incorporating awareness of one’s own biases in areas including gender, race, religion, age, and economic status.

4. Quality and safety are hallmarks of the medical home:

   Practices advocate for their patients to support the attainment of optimal, patient-centered outcomes that are defined by a care planning process driven by a compassionate, robust partnership between physicians, patients, and the patient’s family.

   The Core Curriculum contains two related elements:

    1. Recognize the role of patient advocacy in the practice of medical assisting.

    2. Advocate on behalf of patients.

Therefore, CMAs (AAMA) are educated not only to be “communication liaisons,” but also to be “advocates” that speak on behalf of patients (with the authorization by the overseeing/delegating physician and other designated health professionals) to third-parties so that the best interests of patients are always in mind.

   Patients actively participate in decision making and feedback is sought to ensure patients’ expectations are being met.

If patients are to “actively participate in decision making” in the Patient-Centered Medical Home, and provide feedback about whether their expectations are being met, at least one “point person” in the delivery setting must be available as the following:

    1. An effective and empathetic communicator to patients

    2. An effective and accurate communicator from patients to members of the health team.

The following elements of the Core Curriculum ensure that CMAs (AAMA) are educated in these skills and professional attributes:

   Explain the rationale for performance of a procedure to the patient

   Show awareness of patients’ concerns regarding their perceptions related to the procedure being performed

   Information technology is utilized appropriately to support optimal patient care, performance measurement, patient education, and enhanced communication.

Within the “Medical Business Practices” of the Core Curriculum is the following element: Execute data management using electronic health care records, such as the electronic medical record (EMR). Quite often, a CMA (AAMA) becomes the “expert” among all health team members on the electronic medical record (also known as the electronic health record, or by other similar designations).

5. Enhanced access to care is available through systems such as open scheduling, expanded hours, and new options for communication between patients, their personal physician, and practice staff.

CMAs (AAMA) have also become competent and adept schedulers in primary care settings—whether such settings incorporate few or many elements of the Patient-Centered Medical Home paradigm. The following Core Curriculum elements provide convincing evidence as to why CMAs (AAMA) are such skilled and knowledgeable schedulers:

  Manage appointment schedule, using established priorities.

  Schedule patient admissions and/or procedures.

Revolutionized care

The Patient-Centered Medical Home will revolutionize the delivery of primary health care and will dramatically increase the welfare of all Americans. In addition, preliminary reports point to the fact that the PCMH philosophy will be reflected in the health care reform proposals of the Obama Administration.

The CMA (AAMA) will quickly become the linchpin of the Patient-Centered Medical Home model. What evidence supports this assertion? First, “The CMA (AAMA) is the only allied health professional who is required to complete an accredited postsecondary medical assisting program that provides specific training for work in medical offices, clinics, and other outpatient care centers.”3 But more specifically, as demonstrated above, the 2008 Core Curriculum for Medical Assistants of the Medical Assisting Education Review Board ensures that CMAs (AAMA) are educated in the cognitive knowledge elements, psychomotor skills, and affective behavior and professional attributes that are key to the successful operation of a PCMH.

The indispensable role of the CMA (AAMA) in the Patient-Centered Medical Home revolution is another reason why medical assisting will continue to be one of the fastest-growing professions during the next 10 years.

Questions? Contact Donald A. Balasa, JD, MBA, at dbalasa@aama-ntl.org or 800/228-2262.