Friday, October 17, 2008

"Medical home": where everybody knows your name

Originally titled "Dr. Ted on 'patient-centered medical home'"

Four weeks ago I posted about a wonderful development: "Patient Centered Medical Home" makes it into NEJM. Today Dr. Ted Eytan of and newly of Kaiser-Permanente, left a comment:

Do you think the description in this article, and this one (on "the medical neighborhood") has enough information about involving patients? How would you advise this body to include them?
Rather than having that discussion get buried, I want to bring it up front.

The short answer is that those articles hardly say bupkus about patients themselves, but that's not what "patient-centered medical home" (PCMH) is about. It's about raising awareness that 40% of Americans don't HAVE a medical home.

When I first learned that last spring, from PCPCC's Paul Grundy (through my fabulous friend Leslie Harkins, who heard him talk), it stunned me. Heck, when I grew up, everyone had a family doctor who knew them. They don't anymore??, I thought.

No wonder, I thought, that PCPCC's data (from Dartmouth) showed such a strong correlation around the world between primary care and lower costs and good outcomes.

But for whatever reason, America's become increasingly focused on specialists, not primary care. And as that's happened, our costs have gone up and outcomes have declined. It's as if the whole system had started out with reliable, cost-effective Toyotas and gone backwards to costly rattletraps.

So I was really happy to see "PCMH" get its first bigtime publicity in a journal the establishment reads!

More about what's in those columns:
Early reports from focus groups suggest that the term "medical home" makes many consumers think of nursing homes, with all the unfortunate connotations.
Maybe they need a marketing consultant. 8^) Here's how I handle that when talking to people:
  • "Home. Y'know, home? Like, the place where you always go?"
  • "Like the Cheers song: 'Where everybody knows your name'."
  • "Robert Frost: 'Home is where, when you have to go there, they have to take you in.'"
Well, okay, we're not yet to the third one - unless you're in the VA healthcare system, or some other countries. But if you've been reading what I'm posting about Best Care Anywhere, that fact may sound peculiarly interesting.

The first article does contain a mention of patients, which I hadn't noticed at first reading, regarding legislation to participate in a Federal demonstration program for PCMH:
These requirements stipulate that medical homes must have "an integrated, coherent, cross-discipline plan for ongoing medical care developed in partnership with patients and including all other physicians furnishing care to the patient involved and other appropriate medical personnel or agencies (such as home health agencies)." [Emphasis added]
Well that's a smart idea!

--- Hey, all you other patients - I know you're interested because you read my blog. :) Would YOU like to be involved in creation of this new system? Same for you healthcare workers - you know better than most people what we could create. Click the Comments link below. (Or if you're reading in email, come online and participate.)

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