08 Jun The "medical home" discussion heats up
MADISON – A dinner presentation about the medical home concept at a recent health care conference moved quickly into a wide-ranging discussion about all that ills the health care system. The session, led by Jim Adams, the executive director of IBM’s Center for Healthcare Management, took place amongst the speakers and advisory board members of the 2009 Digital Health Conference. The conference was held at the Fluno Center in Madison in early May.
Mr. Adams said the patient-centered medical home could be the answer for a health care system in which neither the payer nor the provider is happy with the current situation. Insurance companies and other payors say that what providers sell them is “garbage” and the providers say that what the payers do for them is “unacceptable.”
The solution, Mr. Adams said, is a health care delivery model—the medical home—that “delivers comprehensive care coordinated by a primary care physician-coordinated extended care team” within the context of the family and community. The “proactive focus” of the medical home provides better interventional care and chronic disease management, he said.
Technology and electronic medical records, in particular, may not be the boon to health care that they were once thought, at least for the present. “Physicians will trust clipboard assessments of everything that has ever happened to us,” Mr. Adams said, “but they won’t accept [the information in] a personal health record.” Better technology, infrastructure and clinical content are needed to drive the adoption of the medical home concept.
IBM, Mr. Adams said, believes primary care is the most broken of all parts of the health care system. Primary care, he said, must be fundamentally reformed, a sentiment echoed by the retired chief information officer of Meriter Hospital and conference co-chairman Peter Strombom.
“Today’s primary care is competitive by nature,” Mr. Strombom said. “Doctors build walls around their practices and patients can’t go elsewhere.”
Dinner participants were quick to jump into the conversation.
“One of the problems is that primary care doctors don’t think they’re paid enough now, compared to specialists,” said one dinner participant, and next, speaking as if a doctor, “and then you want me to do medical home?”
The compensation of specialists continues to rise, said another participant. Medical home is a way to elevate primary care physician pay because Medicare and private insurance reimbursement would follow from the additional work they would do under that model.
The shortage of primary physicians was cited as another potential stumbling block to the medical home concept. This shortage has a direct affect on today’s overall health care costs. In regions of the country in which there are more primary care physicians than specialists, costs are compared to regions in which the opposite is true. Other cost-control measures are needed in order for the health care system to deliver care as efficiently as possible.
“What would really help with cost control is if people knew what the cost and price of their health care was,” said one dinner guest. “It would be better, too, if the cost of a test or drug was listed on the doctor’s order form.”
The problem with trying to control health care costs today, said a Madison health information technology executive, is that too often “sick care” is practiced instead of health care.
“Poor health shows up as only 25 percent in direct costs,” said Mr. Adams. “Seventy-five percent of the costs of poor health show up in absenteeism, long-term disability and the like. What’s more, 10 percent of the population with multiple chronic conditions account for 75 percent of the costs.”
As the discussion came to a close and Dr. Barry Chaiken, a Boston-based physician, chief medical officer of DocsNetwork Ltd., and a conference co-chairman, asked the assembly, “Does it tick you off that we pay all this money and we have such a bad system?”
One of the attendees replied, “Let’s not lose sight of the fact that the current health care system has taken away from us the responsibility we have to our own care.”