Friday, September 12, 2008

Primary Care, Paul Grundy - Fixing a Broken System

The following appeared in today's It is Lee Masterson, senior editor of Health Plan Insider. It describes the growing momentum of the Medical Home Movement. RLR

Many believe a recently implemented Physician Group Practice demonstration project could be the future of quality care. Employers are tired of spending billions on healthcare programs that are not adequately caring for their employees. In fact, the current system is "garbage."

That powerful statement was given by one of the biggest proponents of the advanced medical home on Monday. Paul Grundy, MD, MPH, director of IBM's healthcare, technology, and strategic initiatives and chairman of the Patient-Centered Primary Care Collaborative (PCPCC), said IBM and other large employers are funding a broken healthcare system that doesn't prevent illness—and they want a coordinated healthcare system.

Grundy spoke during a Webcast presented by DMAA: The Care Continuum Alliance. He and Bruce Bagley, MD, medical director for quality improvement of the American Academy of Family Physicians, were supposed to speak in Hollywood, FL, that day as part of DMAA's annual forum. But Hurricane Ike had other plans and forced DMAA to postpone its event until November.

But, given the growing momentum behind the medical home concept, DMAA decided to host the two men on a Webcast for those who would have attended the annual forum. The fact that these two men, one from the employer side, the other from primary care, came together to speak on a population health Webcast shows the breadth of support for the medical home. Many healthcare leaders view the concept as the answer to the question: How do we repair a healthcare system that does not pay for keeping people healthy?

On Monday, Grundy promoted the "ideal payment environment," which would include a blended model that combines current flawed payment systems that alone are not working: salary, which creates problems with productivity; fee for service, which causes overuse; capitation, which leads to underuse; and pay for performance, which ignores health issues not connected to payment.

Instead, the PCPCC recommends the following three-part payment methodology:

A monthly care coordination payment for the physician's work that falls outside of a face-to-face visit and for the health information technologies needed to achieve better outcomes
A visit-based fee-for-service component that is recognized for services that are currently paid under the present fee-for-service payment system
A performance-based component that recognizes achievement of service, patient centeredness, quality, and efficiency goals
There has been growing support for the medical home, but there are still those who are afraid of what these changes would mean. Some in disease management/population health are worried that the medical home will take away their power—or much worse that their services will become unnecessary. Some physicians, meanwhile, are concerned about how care coordination will affect their practice and workload—and whether they would get paid adequately for the added work.

There is no question that population health's stature will change under a medical home model. But Bagley said the industry should not fret—population health will play a key role in the potential success of the medical home.

Bagley said under the medical home, population health companies will move from helping individual patients cope with chronic illness to assisting primary care practices help patients cope with chronic illness and integrate their services into the practice flow to help care teams.

There are great opportunities for population health, Bagley said, such as supporting office transformation, training office staff for registry and care coordination functions, supplying patient safe-management support, providing community-wide care coordination services, and offering 24/7 nurse help lines.

The medical home will change population health, but its leading advocacy group, DMAA, is already behind the idea. Tracey Moorhead, president of DMAA, said her organization sees the possibilities and is building relationships with physician groups, which traditionally have been cool to DM.

For supporters like Grundy, the issue goes beyond payment models and shifting control. The current system is "immoral" and the medical home is about doing the right thing. "I want to buy this kind of care because it's the right thing to do."


Les Masterson is senior editor of Health Plan Insider. He can be reached at

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