Medical home model champions patient-centered care

The goals of the Patient-Centered Primary Care Collaborative (PCPCC) are hard to argue with. The coalition of employers and physician groups hopes to transform how primary care is organized and financed. It says patients will get better treatment, physician payments will be improved and value will be added for purchasers and consumers by allowing patients' family doctors to coordinate care. That coordination will depend on technology.

"I was in a primary care office in Denmark when a patient who needed an aortic valve replacement walked in," he says. "The doctor and patient went online together and looked through images and information that they discussed. They then brought up every hospital in Denmark that did valve replacements. All of the information they needed was right there, from the hospital's rating on the procedure to when it could be scheduled. They made a decision based on the needs of the patient and scheduled the procedure around his daughter's graduation."

"Setting up systems where patients and families can access their health records via the Web has been done, and is being done, all over the country," says Andy Spooner, MD, FAAP, chief medical information officer at Cincinnati's Children's Medical Center. "But it's not step one for most child-health providers. Depending on what survey you read, 70% to 90% of people who care for kids have no electronic medical records at all. You have to implement the system for your own office before you can begin to offer records online for families."

Dr. Spooner is a former chair of The American Academy of Pediatrics, which is part of the PCPCC, along with The American Academy of Physicians, The American College of Physicians and the American Osteopathic Assn. Collectively, these associations represent 330,000 physicians and medical students who deliver primary care nationwide. Because technology costs have traditionally been the responsibility of physicians, any new technology needs to prove a tangible return on investment to be widely adopted.

"Who's going to pay for it? That still needs to be sorted out," says Dr. Grundy. "But all this gnashing about who's going to pay for what is ultimately irrelevant. With the system we have now, we're going to go broke if we stick with the status quo."

He says the Danes spend one-third less per capita than we do, and their administrative spend for healthcare is one of the lowest in the world. Improving efficiencies and reducing waste in the U.S. system would pay for the upfront implementation costs, as small-scale programs and an initiative in North Carolina have shown. North Carolina Medicaid created 15 community-based networks based on the medical home model. About 3,500 primary care physicians participated. An upfront investment of $10.2 million saved $244 million in overall healthcare costs for the state.

Up-front technology costs aren't the only hurdle. The red tape is just as challenging. From privacy issues to data standards, the medical home model will require new laws and mandates to reach its full potential.

"We have a long way to go before agreeing upon standards for how information systems ought to work," says Dr. Spooner. "But without standards, we cannot build a national health information infrastructure."

PAYMENT PREDICAMENT

How care is purchased is another fundamental change that is needed, according to Dr. Grundy. IBM spends $2 billion for healthcare annually.