Our fragmented healthcare delivery system is struggling to meet the needs of a massive and growing population (130-140 million) of people living with chronic diseases and conditions such as diabetes, heart disease, asthma, depression and obesity. Everyone from providers and payors to politicians and economists is talking about the importance of addressing this population that is responsible for a majority of our nation’s healthcare expenses – but few solutions, to date, are truly engaging consumers and producing the results needed to reverse the troubling trends of rising costs and declining health outcomes.
Patient-centered medical homes (PCMH) have been discussed for years now in the context of a new, or old, approach to care coordination and delivery but few physicians, hospitals and insurance companies have moved beyond talking about this new model to actually developing and deploying it. At its essence, this model was designed for the effective treatment and management of chronic conditions. It supports a transformed reimbursement system that helps enable performance-based rewards for both physicians and patients by placing a great emphasis on disease prevention, symptom monitoring and proactive interventions.
Properly executed, the primary care physicians supported by lower-cost nurses and medical assistants (assisted by technology-enabled “extender” solutions) serve as the point of access and healthcare guide or advisor to help patients successfully navigate the healthcare system, connecting them with specialty care only when needed. The successful implementation of this integrated, collaborative, “patient-centered” approach to healthcare delivery promises to increase efficiencies while developing and maintaining a more holistic view of patients and populations. Unfortunately, the patient still seems to be missing from the equation in most of the medical home pilots that I have reviewed.
Most physicians will quickly admit that they do not have the time or resources, nor do they have the training, during office visits to help patients reverse the unhealthy behaviors and lifestyles that are usually deeply conditioned in their daily routines. In the current system, physicians are pressured to review a patient’s history, perform an exam, prescribe or alter medications, counsel on compliance, and provide information on the prevention and treatment of various conditions in less than twenty minutes. This environment makes it very difficult for the physicians and their staffs to actually educate and empower their patients to improve their condition by changing their behavior through the adoption of new lifestyles and programs. Furthermore, the current nature of episodic provider-patient relationships makes it very difficult for healthcare professionals to establish and maintain knowledge of (and influence upon) the patients’ lifestyles and healthcare issues between visits.
Since chronic conditions are primarily managed between doctor visits, the insurance companies and self-insured employers that must assume and attempt to manage risks associated with healthcare of their members and employees are unable to rely upon providers to reverse the negative trends. To address this obvious problem and increase collaboration among the stakeholders in our healthcare system, there are many new models and technology-enabled solutions being introduced with a promise to increase the efficiency and efficacy of care.
This new approach to care delivery and reimbursement with obvious benefits to all parties has been over-analyzed and tested. It is time that we stop talking and start walking to deploy medical homes that are truly patient-centered with an objective of decreasing costs and improving quality (outcomes) across the system. Increased information sharing and collaboration between payors, providers and patients will lead to less-fragmented, lower-cost delivery of care. The healthcare professionals, companies and organizations that are committed to this model are shaping the future of healthcare.
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