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Joint Principles 2.0: The Pursuit of the Real Medical Home

Posted By Matthew P. Martin, Thursday, August 7, 2014
(This blog post is based on the recent press release by the Families, Systems, and Health journal)

Constructive criticism and I have a, well, complicated relationship. I welcome criticism and then sometimes run away from it with my arms wide open. The first manuscript I ever submitted for publication was ripped to shreds by the reviewers. The little writer inside of me slipped into a coma after that doozy. But I survived and my writing vastly improved.

 

It’s not always easy to swallow criticism but how else do we improve? Here are some well-worn analogies that might illustrate this point. Criticism is the asphalt that lines the royal road of progression. How about this one? Criticism is the currency of the science kingdom. It allows us to operate the marketplace of innovation.

 

OK. You get the point: when someone shines a stadium light on your overseen deficits, just know that it’s for the best.

So why was I glad to see the recent call for integrating behavioral health care into the Patient-Centered Medical Home (PCMH)? Is it because I love behavioral health? Well, yes, that is true. But more importantly I value progression. This new report calls for making behavioral health care a central component of the PCMH. Isn’t science great?!

Here is what the new report calls for:

• Have a whole person orientation
• Help patients adopt healthy behaviors and treat common mental disorders
• Be coordinated and integrated within teams rather than fractioned between providers who do not collaborate
• Emphasize safe, high quality care
• Make access to behavioral health service as available as access to medical care
• Use payment models that promote shared care and shared responsibility by primary care teams


It has taken this long to make a formal call for recognizing the importance of behavioral health in the PCMH The original Joint Principles were published in February 2007 at a time when J. K. Rowling had announced the release date of her final Harry Potter book, the Indianapolis Colts had beaten the Chicago Bears in Super Bowl XLI, and George W. Bush was still POTUS. That was seven years ago. It has taken this long to make a formal call for recognizing the importance of behavioral health in the PCMH. But I’m OK with that because scientific progress marches onward. In fact, the authors of the Joint Principles 2.0 (my title) stated “PCMH is an innovative, improved, and evolving approach” (my emphasis). We are headed in the right direction.

Despite the numerous endorsements by major professional organizations for Joint Principles 2.0 (I count at least seventeen), there are still significant concerns about the current state of the PCMH model. The June 2014 edition of Families, Systems, and Health features commentaries from eight health care organizations that offer support and criticism for the Joint Principles. Here are some of the actual comments:
 


• “The treatment of patients is best done in collaboration with intimate networks and larger community and cultural connections” (
full article)

• “Medical homes integrating behavioral health [should] follow principles that extend leadership and participation to all fully qualified providers, including nurse practitioners” (full article)

• “[t]he Joint Principles could underscore further the vital role of the family in a PCMH. … the supposition of a physician-led health care team proposes an overly narrow model.” (abstract)

• “Separate and unique confidentiality requirements for behavioral health conditions are deeply associated with the still-too-present discrimination and stigma connected to mental disorders” (abstract)

So, is there a Joint Principles 3.0 on the horizon? Will the next vision for PCMH include close collaboration with families, a more flexible leadership position, and unified behavioral and medical documentation systems? I certainly hope so. But even the most sound and well-worded criticism can fall on flat ears. If the real medical home is going to emerge, it’s not going to be with bullhorns and proclamations. It’s going to be through tough-as-nails research and constant critical analysis. It took seven years to even start talking about new PCMH principles. Will it take another seven years to start practicing them? Progression can be slow at times, but hopefully not that slow. If the real medical home is going to emerge, it’s not going to be with bullhorns and proclamations 


Matt Martin, PhD, LMFT is a licensed marriage and family therapist and current Director of Applied Psychosocial Medicine at the Duke/Southern Regional AHEC Family Medicine Residency Program in Fayetteville, NC. He is current editor of both CFHA blogs. His interests include integration of behavioral health services in primary care settings, behavioral science curriculum development, family-centered primary care, and self-awareness development in family medicine residents. Email: matt.p.martin@gmail.com

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