The Jury Is Out On Patient-Centered Medical Homes
Significant investment in dollars, resources and time is being made by health care organizations to build the infrastructure necessary under the Affordable Care Act (ACA). Quality measurement and reporting requires extensive capital and a move toward standardized electronic medical records. New models such as Accountable Care Organizations (ACOs) and Patient Centered Medical Homes (PCMHs) are being established and vetted, in the hopes of driving improved care cost effectively.
There is little doubt that our current health care system needs reform, as more is spent per patient in the U.S. than in other countries, and tens of millions of consumers were without health insurance coverage prior to the ACA (many still are, but they now have access to coverage via the Exchanges).
Moreover, improvement in care delivery is a very attractive proposition, in an environment where primary care physicians must see 25-30 or more patients a day and patients might get 7-8 minutes with their doctor.
But are these early approaches working?
The Results of New Care Models are Inconclusive
Earlier this month, the Medicare Payment Advisory Commission (MedPAC) voiced concerns over whether the Patient Centered Medical Home model is effective in reducing costs while driving quality through coordinated care.
For perspective, a Patient Centered Medical Home is a model of organizing primary care that is comprehensive, patient-centered, coordinated, and intends to deliver improved access, quality and safety. It’s not so much a place as it is a framework and set of processes.
The National Committee of Quality Assurance (NCQA) — long respected as a “Good Housekeeping Seal of Approval” of sorts for rating health insurance company quality — is the certifying agency for PCMHs. Many health insurance companies will pay bonuses to participating health care organizations based on the number of patients being managed through this coordinated care.
However, MedPAC Chair Glenn Hackbarth, JD stated, “In order to meet all the NCQA requirements, there are a lot of bells and whistles that have been added. My impression is that not all of them have really been validated as added value, but they add cost. I’m worried that maybe the medical home model has a real cost disadvantage.”
There is Promise
As Fred N Pelzman, MD writes in his article “Patient-Centered Medical Homes: Is the Devil in the Details?”:
“Don't tell me this stuff won't work. This is baseball, apple pie, and motherhood. Creating new ways to improve access to care? Nothing wrong there. Improving coordination of care between all the healthcare providers caring for patients? Cannot be bad. Giving providers more tools to improve quality? Unlikely to make things worse.
Now I'm sure that we don't have the payment model worked out right, and I'm sure there are a lot of growing pains to come as we try to figure out where the bang for the buck lies, but forging ahead makes sense, because the system we've been operating under now is broken. Broken, broken, broken.”
I couldn’t agree more. However, all the capital investment and technology in the world will have limited effect if patient behavior isn’t addressed.
When medication compliance is still only 50% across most health conditions, a sizeable portion of the public does not practice wellness and prevention, and a quarter of consumers admit to being “couch potatoes” (2013 c2b Consumer Diagnostic), PCMHs face an uphill battle.
Address this human element along with the infrastructure, and the promise of PCMHs could be delivered.
Patient Behavior Change is Key
c2b solutions has conducted extensive market research on consumers’ behaviors and attitudes regarding health and wellness. Using deep consumer insights, we are working with health care organizations to drive positive patient behavior change by appealing to consumers’ deep-seated motivations. Our proprietary psychographic segmentation model (patent pending) has demonstrated the ability to trigger proactive behaviors in the most challenging patient types.
Augmenting coordinated care with consumer insights and patient-preferred approaches could help achieve the results MedPAC seeks.
The intention behind the PCMH model is commendable; before the model is discounted as ineffective, I hope PCMHs (and other innovative models like ACOs) are given the chance to provide optimized care.