WASHINGTON – A who's who list of physician organizations, advocacy groups, pharmaceutical manufacturers, and employers is throwing its weight behind the idea that the medical home model can cure much of what ails the health care system.
At a recent meeting of the Patient-Centered Primary Care Collaborative, 13 physician specialty groups–including the American College of Physicians, the American Academy of Family Physicians, and the American Academy of Pediatrics–signed on to the joint principles for a comprehensive, primary care, evidence-based, and physician-directed medical home. The principles also are supported by a variety of other organizations, including many large corporations.
“I have been a family physician for 31 years … and I have never been more excited about the future of health care,” said Dr. Doug Henley, executive vice president of the American Academy of Family Physicians.
In March, the Association of American Medical Colleges adopted the position that everyone should have access to a medical home.
“Many Americans, even among those with comprehensive health insurance, feel 'medically homeless' and lost in a system that is difficult to navigate when they require care,” AAMC president Darrell Kirch said in a statement. “The medical home model holds great promise for improving Americans' health by ensuring that they have an ongoing relationship with a trusted medical professional.”
It's not just national groups that are buying into the concept. At least 41 states are preparing or considering pilot projects to implement the medical home model. Medicare is scheduled to launch a demonstration project next year, and Wal-Mart has begun to explore the model.
“We listen to our customers,” Dr. John Agwunobi, president of Wal-Mart's professional services division, said at the meeting. “We hear them saying that health care is too costly, too complicated, and too controlled.”
There was no apparent consensus on what is needed to make the idea of a medical home into a reality.
Although all of the groups have signed on to the joint principles, that endorsement doesn't imply specific responsibilities. Nor does it imply that everyone agrees on what defines a medical home. A wide variety of measurement tools now being developed can be used to gauge and document the success of a medical home, and that is just the first step. “Measurement is an extremely powerful tool. But it is only that. It is not an end in itself. … It gives us a compass so that we can see where we want to go and whether we are going in the right direction,” said Dr. David Meyers of the Agency for Healthcare Research and Quality. As director of AHRQ's Center for Primary Care, Prevention, and Clinical Partnerships, Dr. Meyers has helped develop a survey tool for measuring care coordination.
Comprehensiveness is the linchpin. The principles of a medical home include providing all services each patient may need or, if necessary, making sure the patient has access to care outside the practice. In other words, the physician providing a medical home is responsible for ensuring that patients get appropriate care, while avoiding the trap of the gatekeeper era in which doctors found themselves in the position of denying care, Dr. Meyers said.
Using measurement tools to show progress and prove the value of the medical home concept quantitatively will be just one challenge, speakers emphasized.
Physicians, especially those in small or solo practices, will need to be shown that it is worth their time and trouble to adopt quality improvement measures, with only the promise of additional compensation. Patients will have to be educated on what a medical home is, why it benefits them, and how they can get one. And payers will have to be convinced that they are getting more for their money.
“Timing is everything,” said Helen Darling, president of the National Business Group on Health. The country is in a recession. Companies are going bankrupt or, at the least, cutting costs. “This is not a good time to talk about spending more money.” She encouraged the group to make sure that adoption of the medical home model is budget neutral.
Many of those at the meeting appeared undaunted.
After 29 years of practicing medicine, Dr. William Jagiello said that he found himself frustrated by a system that fell short of expectations–both his and those of his patients.
“I thought about all the things that I should have done for my patients and did not do,” said Dr. Jagiello, an Iowa family physician. “It began to dawn on me that the medical home concept would give me the process and the vehicle through which I could be doing all those things for my patients on a daily basis. And perhaps I could come home a lot more satisfied and less exhausted knowing that I have delivered the best care possible.”