Thursday, May 8, 2008

Patient-Centered Primary Care

I've recently been learning about a movement that started forty years ago: the "medical home." This is the idea that each of us should have a place we call home, medically. At first it was about keeping all your records in one place, but now it alludes to the reality that 40% of Americans don't even have a doctor's office they can call "home."

And the movement asserts that there are real, verifiable, measurable consequences of lacking that continuous care from a primary doctor who knows you.

I learned about this via the Patient-Centered Primary Care Collaborative (PCPCC), an employer-based coalition founded by IBM. Think about it: since employers pay the lion's share of health insurance, they have a strong interest in improving the cost-effectiveness of the health care they buy.

IBM also happens to employ people around the world - so they have tons of data about which systems work better and cost less. Guess what: there's clear evidence that where people have better primary care, their total healthcare bill is lower and their outcomes are better.

Yes, what works is to have a good old-fashioned family doctor, who actually knows who you are!

Here are some slides that have been loaned to me by Paul Grundy MD of IBM, chair of PCPCC:

Disclaimer: I haven't personally done the research to verify the graphs shown in the slides. Anyone who has information to support or discredit these slides, please comment here.

No flaming, though! This isn't that kind of blog. Just information, please.

1 comment:

  1. Dave
    The PCMH framework and principles as described by Grundy are wonderful and I give them my full support.
    The problem is the gap between those principles and the unfortunate choice of the NCQA's PPC-PCMH(tm) tool as a yardstick to measure the success of PCMH projects.
    The yardstick is broken, therefore the processes using that yardstick are likely to result in flawed material and not live up to the principles.

    As an example: PCMH stands for Patient-Centered Medical Home. The Joint Principles talk about comprehensive, whole-person care from a personal physician.

    Good data show us that patients can accurately report on these critical qualities in practice, that patient-reported data are meaningful, that patient-reported data can help practices improve their processes, and once improved will achieve better results for same said patients.

    How much does the NCQA value patient input? 3% of the score comes from the patient experience.

    The discordance is very unfortunate as the current medical home projects - almost ALL of them - are using the current version (so don't be swayed by NCQA's promises to fix this in future versions).

    I'm concerned that this whole first generation of medical home projects are likely to achieve little meaningful improvement given the lack of patient experience as the keystone to the arch of quality.

    Gordon Moore


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