Sunday, September 7, 2008

Personal Physician, Paul Grundy - From Anonymous to Personal Physician Care:

Accentuate the positive.
Eliminate the negative.
Don’t go with Mr. In-between.

Lyrics of World War II Song

The law of unintended consequences is perhaps less of a “law” than a simple statement of fact: We cannot accurately predict all the results of our actions.

Janet Rae-Dupree, “When Academia Puts Profits Ahead of Wonder,” New York Times, September 7, 2008

Too many people have no relationship with a personal physician who cares about them. It’s not the disease, or the organ system, you have to focus on but the patients themselves.

Paul Grundy, MD, IBM, Director of Health Care Transformation, Personal Communication, September 4, 2008

Powerful managed care companies, prestigious academic centers, wondrous high innovations, insatiable consumer demand for access to specialists who deploy the technologies, and unfettered Internet information, good and bad, has consequences – distancing of patients from personal physicians, “disintermediating” of the patient-physician relationship.

I recently interviewed Paul Grundy, MD, who leads IBM’s efforts as a major health care buyer, to transform health care by strengthening doctor-patient relationships
and paying primary care doctors more to do the right things.

Towards that end, he and others founded the Patient-Centers Primary Care Collaborative in September 2006 in collaborative with other major big business buyers and a quartet of primary care physicians representing 330,000 physicians – The American Academy of Family Physicians, the College of American Physicians, the American Academy of Pediatricians, and the American Osteopathic Association.

Grundy’s thesis – based on IBM’s experience as a buyer of care in multiple countries, a large literature on primary care efficiencies, and visits and talks with hundreds of American primary care physicians -is this: an intimate bond between patients and their personal physicians fosters prevention and wellness, reduces costs by 30%, and improves outcomes by 20%.

Achieving these results, Grundy says, requires three things;

1) Big business and federal buyers focusing on “buying care” through medical home type arrangements that offer coordinated comprehensive care.

2) Payers rewarding primary care doctors that offer convenient patient-centered services – rapid responses to emails and phone calls, same day appointments, advice on wellness and prevention, and frequent communication and follow-up care.

3) Payers, public and private, helping develop physician-led efficient and affordable electronic record systems that help patients, physicians, and hospital communicate with as few clicks as possible.

Grundy is the first to admit it’s a long way from Tipperary to the tipping point to achieve these goals. It will take a high order of collaboration and a change in mindset from consumers and stakeholders in our top-heavy over-specialized culture. That’s the main reason Grundy calls his efforts “transformational” rather than “reformational.” But Grundy believes Big Business wields a big stick – its financing of nearly half of U.S. health costs.

As an aside, it seems to me Senators Obama and McCain are missing or ignoring a big bet in their health reform plans. As the AMA News reports in its September 1, 2008 “Campaign Case Report,” “neither candidate addresses the physician work force issue.” Neither says that there’s a desperate shortage of primary care doctors, that these physicians are struggling to survive, that they are not entering or are fleeing primary care, that increasing numbers of them are declining to see Medicare or Medicaid patients, that one of six are considering switching to retainer or cash-only or locum tenens practices, that they are not adopting EMRs because they are already overwhelmed with high costs, no time, or swamped with patients, that universal or even expanded coverage is meaningless without access to primary care physicians.

Now is an apt time for the good Senators to:

1) Accentuate the positive and irrefutable fact that a well-paid primary care base is the single best way to satisfy patients, cut costs, and produce superior results.

2) Eliminate or reduce the negative by openly admitting that 25 years of managed care and other technological advances have separated patients from their personal physicians.

3) Saying that “Mr. In-Between”, 3rd party intermediaries with all their rules, regulations, and data-parsing have done little to satisfy patients or doctors or improve results.

But take heart. As I concluded in the closing paragraph of my 1988 book “And Who Shall Care for the Sick? The Corporate Transformation of Medicine in Minnesota.

Perhaps I’m looking through the glass too darkly. Perhaps with an aroused profession with a closer relationship with patients, we’ll be able to help patients make more informed choices, prevent their diseases, promote their health, and choose among the innovate therapies, ideas, and technologies only a dynamic and competitive system can produce.

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