Many people would argue today that there are serious problems in our health care system. We pay twice as much as other countries for health care, but our outcomes are no better and, in many cases, worse. Other countries utilize the patient-centered medical home (PCMH) model of organized, comprehensive, coordinated primary care as the foundation for their health care system. We can learn a great deal from the success of other countries.
Rebuilding our delivery systems should be the same as rebuilding a house; one should start with the foundation, says Jim Byrne, M.D., M.S., chief medical officer with Priority Health.
Smart Business asked Byrne about PCMH, how it affects overall health care and why employers are moving toward such care.
What is the patient-centered medical home?
A medical home is not so much a place as it is a relationship, one that involves a patient and his/her personal physician. That physician leads a team within the PCMH that provides all the preventive and chronic care that the patient requires. This care will vary depending on age and gender. This physician is both knowledgeable and accountable for all patient care, whether in the office, hospital or elsewhere.
In this relationship, patients take accountability for their own health care. They are informed and activated to manage their own health in partnership with the personal physician. Health care is very complex in the 21st century. As more technology becomes available, it will be an invaluable asset for patients to have one knowledgeable human being who can oversee their care. This model has significant benefits to health care such as improved access; organized, comprehensive, high-quality and affordable care; and focus on the individual patient as a partner in overall health care.
If primary care physicians are providing care instead of specialists, is there a risk of a decrease in the level of care?
No one is advocating a return to the era of requiring primary care physician (PCP) approval of all referrals. Rather, this model allows the patient and the care team to work together to make sure the patient gets care in the right place. This includes, for example, getting care in the PCP office instead of the ER, avoidance of duplicative testing, monitoring of all of a patient’s medications to avoid interaction, duplication, etc.
If patients receive all of the age/gender care that is appropriate for them based on the best clinical evidence, it can be described as optimal care. A study published in 2003 showed that, on average, patients get only about half the recommended care.
Why are employers supporting the patient-centered medical home?
With the optimal level of care provided and patients activated to improve the aspects of health that are manageable through their own efforts, employers will see fewer lost workdays, higher productivity and lower trends in health care costs.
How do employers implement such new care practices for their employees?
The alignment of the personal physician with the insurer and the employer provides a terrific opportunity to drive the improvements that the model promises. One example is the employer selects a benefit design that asks the enrollees to:
The employer can attach economic incentives to these benefit plans that will help promote these behaviors.
Employers are also positioned, in many cases, to support behaviors that promote healthy lifestyles and personal accountability for health management. Examples: smoke-free environments, smoking cessation programs, health club memberships, etc.
How does the patient-centered medical home affect the future for physicians?
The number of new physicians going into primary care is dwindling rapidly. This model, as noted, will improve patient care. However, if the change is to be sustainable, it must also produce improvements on the physician side — namely, in professional satisfaction and by addressing reimbursement deficiencies.
Such a change will not be easy. To transform from current state to PCMH is a daunting challenge. It will take years and there will be significant cost. Physicians need to reorganize the way they deliver care. It will require investment in people and technology (electronic medical records, portals, e-visits, etc.) that will greatly improve care in the 21st century.
Primary care would present a much more compelling image if practices had the infrastructure and organization required to provide the kind of care that the model dictates and if they could be assured of a reasonably competitive income as a reward for the value that the model provides.
JIM BYRNE, M.D., M.S., is chief medical officer with Priority Health. Reach him at firstname.lastname@example.org or (616) 464-8362.