A new spin on primary care Featured

7:00pm EDT January 26, 2009

If you took a snapshot of the current health care system in this country, it would not produce a pretty picture. Physicians are under constant pressure to see more and more patients in less and less time.

Health care costs continue to rise faster than the economy. Employers, government and individuals feel increased financial burdens and still health care in the United States compares unfavorably to much of the rest of the industrialized world.

The reason for the unnecessary and inappropriate health care services that people receive in the United States is that there is little or no coordination of patient care among providers, says Michael Culyba, M.D., vice president of medical affairs for UPMC Health Plan.

“We also need to recognize that primary care in this country is a failing entity,” says Culyba. “We need to redefine and redesign primary care. That is a basic concept of the patient-centered medical home.”

Smart Business spoke with Culyba about the patient-centered medical home model and how it can improve the current health care system.

What is a patient-centered medical home?

It is an update of the old concept — the family doctor. It is also a way of approaching health care that differs greatly from the current system. Essentially, the patient-centered medical home means physician-guided, patient-centered care. The partnership between the provider, the patients and their families is what makes it work. From this partnership comes a holistic, coordinated plan of care that uses evidence-based medicine to produce better outcomes and lower costs.

How does this differ from the current system?

It differs in many ways. Most significantly, it would change the basis of how care is administered. At present, most care is episodic, illness-oriented and complaint-triggered. With the patient-centered medical home, care will become a patient-centered, physician-guided, cost-efficient model that encompasses both the art and the science of medicine. Prevention, wellness and health will be its focal points.

Physicians will become partners with patients and insurers in coordinating and facilitating care to help patients navigate the health care system. Patients will have a personal physician who works with a team of health care professionals in a practice that is organized according to the principles of the medical home. Patients will be treated within a context of their personal medical history and life circumstances, rather than just focusing on a specific disease or conditions.

There is much research around the world that demonstrates that where patient-physician relationships focus on primary care, people live longer, populations are healthier, there is higher patient satisfaction and costs are lower. The emphasis on preventive care that results from a system such as this can help to lower disease rates and reduce hospital stays.

How does patient-centered medical care differ from traditional disease management?

Most disease management programs use case managers who are provided by the member’s health plan. The primary relationship in that arrangement is between the case manager and the member. In the patient-centered medical home model, care and the coordination of care is the responsibility of the member’s personal physician and the physician’s health care team. The health plan provides information designed to help the patient and physician work together to set specific health care objectives and choose the best way to achieve those objectives. The member becomes more engaged in his or her health care, and the health care system will be better able to serve the needs of individual members.

What are the biggest factors driving the introduction of this new concept today?

The current system is not prepared to meet the needs of an aging population, either now or in the future. Primary care in this country is a failing entity. Each year, the number of primary care physicians drops by 6 percent. We need to redefine and redesign primary care with the patient-centered medical home. New ideas not only add value, they introduce new perspectives from which we can examine value and extend it. The world of health care is one of constant movement and transition. But the main objective never changes: the well-being of the patient.

How can this system benefit employer groups that provide health care for their employees?

If this concept is able to redefine the concept of service excellence, it will be a start toward making health care work better for all of us. That will mean more efficient care, healthier employees and lower costs. This will work through a series of partnerships. The health plan partners with its members, with the employer groups it works with and with its physician community.

MICHAEL CULYBA, M.D., is the vice president of medical affairs for UPMC Health Plan. Reach him at culybamj@upmc.edu or (412) 454-5532.