Keeping the Medical Home Fires Burning

Key Words – medical homes, patient-centered home, physician-directed care, coordinated and integrated care, enhanced access, lower health costs, improved outcomes, personal physician, primary care

Summary of interview with Paul Grundy, MD, Director of Health Transformation at IBM and President of Patient-Centered Care Collaborative

Preface: Dr. Paul Grundy believes empowered primary care physicians will change the U.S. health system for the better. Grundy oversees buying of health care for IBM employees worldwide. He maintains other countries with primary care- based systems with physicians using electronic records deliver better care at lower prices. The complete interview will appear in www.modernmedicine.com

“A: Why is IBM involved with the medical home concept?”

“Q: Basically the IBM approach is about taking the health care we now get as a buyer of care, which we consider to be of high cost and low quality, and migrating it to a lower cost, higher quality care. We want to get better value out of the health care we buy for our employees.”

“When we look at the data and read the reports, we find that an ongoing relationship with a primary care doctor, and the patient knows the doctor’s name, it costs us one-third less money, has lower mortality, and patients are 12% less likely to be obese or to smoke. A close doctor-patient relationships are powerful.”

“Q: How is the Medical Home concept progressing?”

“A: On October 12, 2009, the Veterans Administration defined the Medical Home concept, and the set of principles surrounding it, as the standard of care. Before that on September 18, 2009, the Department of Defense declared the Medical Home as the standard of care. The DOD sent out a directive saying that every DOD member would have a Medical Home.”

“I just left a wonderful meeting in North Carolina, where the 25 residency training programs in North Carolina, South Carolina, and Virginia , the I-Three Collaborative, agreed to work together to migrate towards the Medical Home.”

“The Medical Home, and its principles have been agreed upon by the major primary care societies, and are endorsed by the American Association of Medical Colleges, the AMA, and most Fortune 500 companies as a good path to follow to migrate towards a more robust system with affordable accessible primary care. “

“Primary care doctors should focus on two issues: patient relationships and diagnostic dilemmas. Instead they spend two-thirds of their time looking for rubber gloves, tracking down laboratory results, answering phones calls from insurance companies, and doing everything but focusing on their core business."

"Interesting results are occurring in Medical Home pilots. In Pennsylvania, the Medical home rollout is now moving into its third year. We’ve seen a 15% reduction in costs in ambulatory sensitive conditions. More interestingly in all of those practices that were full and closed have opened their doors and are seeing more patients. This is happening everywhere because in the Medical Home model of care, where everybody works as a team, the Model Home is adding efficiency.”

“Q: So there’s an increase in throughput and productivity?”

“A: Absolutely, an increase in quality and income as well. Two or three years down the road, physicians in these practices are saying, “Thank God, I did this.” They are thinking about quality improvement and are asking themselves, “How can I do this better?” “How can I center more on my patient’s needs?” In our demonstration projects with the American Association of Family Practice, we found Medical Home practices were making, on average, a 14% better income.”

“Q: Are you optimistic reform will come?”

“A: Yes. There are two issues: reform and transform. There are a tremendous number of tools, of ammunition, that have already come down the pike and point to transformation. Health Information technologies (HIT) will be a powerful transforming force. HIT will do for doctors’ minds what X-rays did for their vision. It will change how they look at things, the way they analyze data. “