Monday, January 26, 2009

Medical homes, Paul Grundy - IBM and Health Care

I don’t know what impact IBM will have on health reform.

I do know IBM is a big buyer ($2 billion) of health care for its employees worldwide. I do know Paul Grundy, MD, IBM’s Director of Healthcare Transformation, envisions the medical home as a powerful instrument for reviving primary care. I do know IBM is a powerful and decisive leader among corporations in making health care more rational and less costly.

And I do know an IBM team has published a white paper on its vision of what health care is likely to look like in 2015. Visit if you’d like to read the white paper.

Reading a summary of the white paper reminds of the story of the mother and father watching their children play in the newly laid concrete in front of their home.
The father is furious. The mother turns to her irate husband and says, “But, Dear, I thought you loved children.” He replies, “In the abstract, not in the concrete.”

In the abstract, IBM envisions four generic delivery models.

Community health networks offering access across a defined geography (in the concrete, this is the environment in which most physicians practice).

• Centers of excellence, emphasizing quality and safety (in the concrete, these are usually academic or health systems experienced in treating or evaluating major high ticket disorders).

Medical concierges (In the concrete, these are generally private practices focusing patient-centered care with more time and assiduous attention to patient needs).

Price leaders (In the concrete, these are practices, organizations, or new business models stressing productivity, greater patient throughput, and greater and more predictable economic value for consumers)

In the abstract, IBM foresees a number and variety of competencies will be required to sustain these delivery models.

Empowering and activating consumers (in the concrete, I suppose this means forming “partnerships” with patients, informing them, and strengthening patient bonds).

Collaborating and integrating (In the concrete, this is most important in centers of excellence and in concierge practices).

Innovating (In the concrete, this means stressing the flow of new ideas, taking risks, and thinking outside the box).

Optimizing operational efficiencies (In the concrete, this is all about practice management and paying attention to the bottom-line).

Enabling through IT (In the concrete, this means computerizing your practice and using it efficiently in his myriad forms – EHRs, diagnostic support, encouraging and answering patient emails, population health management).

This is a useful framework for thinking about the future, but for most clinicians, trying to make it through their overloaded day, it will be theoretical. IBM insists the status quo is not an option, and coordinated, collaborative, and value-focused care will be needed. The challenge is turning organizational abstraction into the concrete practices.

1 comment:

Kristin said...

Dr. Reece, you often write about a physician's overloaded day. However, you exclude the behemoth file management system that threatens to overtake most doctor's offices. Why not delegate some of the EHR tasks you fear to a technician or nurse practitioner, who's primary job is interface between the doctor, the database system and online patients? Perhaps this would improve the level of patient care overall, while reducing patients' urgent demand for their doctors' attention?