A New Vehicle in Healthcare – Something that Isn’t Just Words

A survey came out recently that stated that half of patients haven’t had their doctors talk to them about healthcare reform.  With only two months until the beginning of the open enrollment period (October 1, 2013), there exists a significant knowledge gap for many Americans on what reform means for them and their families.
Whether you can squarely fault doctors for failing to inform their patients of these changes (as their trusted healthcare experts) is uncertain.  As an administrator in the field who works daily with physicians, I believe one measure stemming from the Affordable Care Act that all should know something about–whether or not you doctor mentions it to you–is the concept of a “patient-centered medical home” (Medical Homes or PCMH).  More than just a physical location, a medical home is a philosophy that places the patient at the center of care delivery where his or her care is coordinated, accessible, and focused on quality and safety.  It requires a partnership among practitioners, patients, and their families that will ensure that decisions respect the patients’ needs and preferences.  Care is coordinated among a team of providers (not a simple hand-off as typically done  today) and technology is effectively used to easily store and transfer critical health  information.  Notably in a medical home, there is an increased emphasis on patient quality and how evidence-based medicine can drive to better health outcomes.  Here is a good site that does a better job than me explaining a PCMH.

The basic idea behind a medical home is that regular access to primary care allows us to live longer, feel better, and be more productive in society.  Primary care providers (PCPs) are typically the first contact we have with the health care system.  As most Americans rightfully see it, PCPs have a responsibility to diagnose and treat common illnesses and minor health problems.  They offer a wide range of preventative services like flu shots, cancer screenings, diet counseling, and chronic care management.  Research has shown that people with access to a regular primary care provider are less likely to visit a hospital (18% less), have lower death rates from cancer/strokes/heart disease, and cost less to treat (7% savings).

One notable difference to a patient in a medical home is the level of care they should expect to receive from their team of providers.  So often today, people are left to themselves to navigate our overly complex health care system.  In a PCMH, it is expected that you will be a large part in the decision-making process.  Your doctor’s office should be more flexible on office hours and be open on evenings and weekends to accommodate your schedule.  You should be contacted when your prescription runs out and be closely monitored if you happen to be hospitalized for an illness.  And, as so often NOT the case today, a patient should expect a phone call from a case manager or nurse to ensure they have gotten their medications and are clear on their individualized patient care plan.

It isn’t all smooth sailing though.  First, it’s not cheap to be a PCMH, at least in the short-term.  In order to ensure integrated care, physician practices need to invest in expensive technologies like electronic health records that can rapidly and securely share information across networks and locations.  In addition, firms like the Advisory Board have seen that PCMH practices typically require more personnel (PCMHs added an average of 0.6 per FTE physician).  Finally, the administrative paperwork for registering and administering a medical home can be daunting, and significant energies need to be done to do it correctly.   Yet even with all of those headaches, it is hard to argue that these costs outweigh a healthier patient panel in a medical home practice.

Healthcare systems and private clinics around Atlanta are already moving in this direction.  WellStar Health, for example, has a pilot underway with 6 clinics scattered around the city.  Insurance companies are also experimenting:  Blue Cross Blue Shield of Georgia recently kicked off a program that will pay primary care physicians more for being a part of a PCMH model of care.  Nationwide, according to the Commonwealth Fund, private health plans in 49 states are testing PCMH models and 19 states are involved in pilots.

So the next time you enter your physician practice, don’t wait for your doctor to begin the reform conversation.  Speak up.  Several of less known reform initiatives like patient-centered medical homes can dramatically change how medicine is practiced and make you a healthier and happier patient.

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