Medical Home Concept: Will the Patient Centric Medical Home (PCMH) Model Save Primary Care?

This morning at Wired kicks off with Dr. Michael Barr, VP, Practice Advocacy and Improvement for the American College of Physicians.

Dr. Barr introduces tenets of PCMH (Patient Centered Primary Care):
  • Personal physician
  • Physician directed medical practice
  • Whole person orientation
  • Care is coordinated
  • Quality and safety
  • Enhanced access to care
  • Payment to support the PCMH

Designing and delivering care via a "patient centered medical home (PCMH)" is a "team sport" - a physician acting alone can't deliver patient-centric care via a medical home concept.

So who's part of the team?
  • PATIENT (funny, he left this first one off the list - um, by accident I'm sure...)
  • Physicians
  • Nurses
  • Techs
  • Radiologists/Specialists
  • PTs/OTs/STs etc.
  • etc.
I'm following right along with Dr. Barr (head nods in evidence), until he delivers this little gem:

"What we're talking about is practice evolution."

Um, not really doc.

This is why debates about the medical home concept drive me batty.

At conferences, in the literature, talking to physicians, I've seen dozens of variations on the medical home model.

But in reality, medical homes are NOT practice evolution. This isn't rocket science. PCMH = common sense primary care.

What is common sense primary care?

1. Common sense primary care is patient-centric.
2. Common sense primary care is team-based.
3. Common sense primary care makes use of HIT tools to improve care.
4. Common sense primary care provides care coordination via staff/tech.
5. Common sense primary care offers accessibility.
6. Common sense primary care pays physicians for more time spent with patient and for results rather than episodic DRG delivery.

That last one the loo-loo that trips up most reform efforts.

The current US system (much of it) provides REVERSE incentives to improving care efficacy - in our fee-for-service environment the medical home, patient-centric, consumer-directed care will ALWAYS fail. Why? Physicians are paid to deliver SERVICES or TREATMENTS rather than CURES or HEALING

There's another reason I get twitchy during model home discussions - they're window dressing that have little real value to changing behavior (physician OR patient) and improving care.

Why? A perfect environment for which to design tools that encourage and reimburse for continuity and coordination of care already exists - the PATIENT.

The patient is, literally, the 'medical home' within an efficient, empathic system.

Let's start with a question: What is the ONLY node in the entire healthcare system that connects all the other nodes? The PATIENT.

What is the ONLY thing various players have within the system? Caring for THE PATIENT.

ALL goods and services in the healthcare sector, at some point in the food chain, pass through (sometimes literally) THE PATIENT.

Physicians advocating for the medical home concept, great job, but if you don't include the patient as number 1 in the list of players your show will never sell out.

1 comment:

Jenny McGee said...

I agree that patients are the center of all health care, and yes patients and physicians alike will have to change behaviors to improve care, and that is going to take time. But isn’t the medical home just one part of the evolution of patient-centric population health improvement strategies.
For those who might be interested in additional information about this debate, DMAA: The Care Continuum Alliance will broadcast from its annual meeting a complimentary, live Webcast of a keynote presentation on the medical home and population-based approaches to care Monday, Sept. 8, from 10:15 to 11:30 a.m. Speakers are Bruce Bagley, MD, medical director for quality improvement, American Academy of Family Physicians; and Paul Grundy, MD, MPH, chair, Patient-Centered Primary Care Collaborative. Drs. Bagley and Grundy are highly respected experts in this debate. They will discuss the evolution of the medical home and the contributing role of prevention, wellness, disease management and other population health improvement strategies, as well as recognition of the physician as the leader of the care team. If you are interested, you can register at TheForum08.org/Webcast