IBM announced the findings of a major healthcare study that underscores the critical need for a new model of care called the patient-centered medical home. The new study, “Patient Centered Medical Home: What, Why and How?,” identifies the patient-centered medical home as a viable foundation for the reform of today’s unsustainable healthcare system because it is committed to primary-care based, coordinated, proactive, preventive, acute, chronic, long-term and end-of-life care.
Rising healthcare costs continue to be a burden on families, businesses, and the entire economy and are projected to increase even further. According to the Centers for Medicare & Medicaid Services, national healthcare expenditures, already the highest in the world, are expected to grow an average of 6.2% per year from 2008 to 2018 and outpace GDP growth. Moreover, it will consume 20.3% of GDP by 2018.
Transforming healthcare has never been more important, given the current state of the worldwide economy and the downward pressure exerted on the U.S. healthcare system. Medical home practices nationwide increasingly help address fundamental problems with the healthcare system. They can improve healthcare accessibility, consistency and quality of care for consumers, as well as contain rising costs and curb abuse in the system.
According to the IBM study, the broken and disconnected U.S. healthcare system is geared toward treating and rewarding acute, episodic interventions. As a result, the care is reactive rather than preventive: it supports minimal communication between providers and places little focus on patient education and self-management. Healthcare services have been slow to adopt information–based healthcare delivery, in part due to the lack of tools, including electronic health records, that are necessary to provide up-to-date, accessible patient information.
While most Americans would prefer to have a personal relationship with a primary care provider, consumers have expressed growing dissatisfaction with the system in its current state. Patients have reported communications problems with their primary care providers, including difficulties in scheduling appointments, leading to a lack of quality care. Many primary care providers are also dissatisfied because they are confronted with unrealistic demands, insufficient reimbursement, and misaligned incentives. The medical home model improves upon the primary care provider system and can help raise the quality of care while reducing costs.
Benefits of the Medical Home
The medical home, an enhanced care model, provides comprehensive and timely care and payment reform, emphasizing the central role of primary care. At the core of the medical home is preservation of the patient’s personal, long-term relationship with a primary care physician. Patients who have a personal physician will incur less healthcare expenditures and lower mortality rates. According to a 2008-2009 Watson Wyatt study, individuals with a physician are more apt to take preventive healthcare measures and participate in a wellness program. Specifically, respondents who say they have a personal physician are nearly 2.5 times more likely to have had a preventive healthcare screening than those without a physician (76% vs. 31%). Also, workers with a physician are more likely to have taken a health risk assessment (27% vs. 21%), have had a biometric screening (20% vs. 8%) and to have used a weight management program (20% vs. 12%) than those without a primary care provider.
Another key component of the medical home is the team approach to care. Under this model, the patient is at the center of the healthcare experience, supported by a team of care givers who are practicing at the “top of their licenses.” The physician, nurse, nurse practitioner, patient educator, pharmacist, and other care givers all have a role to play in a team-based approach to care with a sense of responsibility for the patient. A primary care provider-led care team becomes the patient’s confidant, coordinator, and advisor for all aspects of healthcare, including prevention and wellness.
Where evidence-based guidelines are available and implemented, often with the support of IT tools, physicians would be able to deliver more personalized and safer care. Patients benefit from more flexible scheduling and from improved communication channels, such as e-mail, phone, or even computer portals where patients can manage their personal health records, monitor their own issues, and even make appointments.
Medical Homes Do Work
Despite the challenges to transforming the U.S. healthcare system, the medical home’s model can be implemented now. Already, pilots in several states have demonstrated success in key areas such as improved quality, greater patient compliance, and more effective use of healthcare services, such as reductions in unnecessary hospitalizations and use of emergency departments for primary care.
For example, the Community Care of North Carolina was formed to reduce healthcare costs and increase access and quality of the state’s under- and uninsured population, which includes coverage for more than 870,000 Medicaid enrollees and 95,000 children. The results of the medical home initiative are positive. A recent study reported that the Community Care of North Carolina produced cost savings of at least $160 million per year. Furthermore, an asthma program reduced hospital admission rates by 40% and a diabetes program improved quality of care by 15%.
Why We Should Care
The study indicates that all stakeholders, including individual/patient, primary care provider, specialist, nurse, hospital, health plan, employer, pharmaceutical organization, government, society, and others, can benefit from participating in the medical home.
Employers, for example, are able to purchase healthcare base on value and can potentially see cost savings associated with more efficient healthcare. Evidence shows that primary care has the potential to contain costs, improve quality of care, and increase employee satisfaction with the medical coverage. Primary care is the site of the most treatments for chronic conditions and has the potential to produce better patient outcomes and reduce the absenteeism and low productivity associated with chronic diseases.
The chart below compares the current healthcare system with the use of medical home care.
Source: Adapted with permission from F. Daniel Duffy, MD, MACP, senior associate dean for academics at the University of Oklahoma School of Community Medicine
There is a greater need to continue to build out the IT infrastructure to ensure that medical homes are operational in the United States. The study emphasizes that medical homes should leverage fully functioning, secure interoperable electronic health records with powerful decision support capabilities connected to their own practice management system and other information sources, such as health information exchanges or other providers’ systems. Many physicians who participate in medical homes have electronic medial record systems, but they are out of date with limited functionality and interoperability. In addition, information exchanges are still in the early stages in most parts of the country.
In addition, practices may need other IT-related capabilities such as disease registries, e-prescribing, quality reporting, patient portals to facilitate e-visits, online appoint scheduling and other capabilities, or portals to facilitate physician-to-physician communication for care coordination. The study emphasizes that it is important to have a standards-based technology infrastructure to support larger implementations.
The study concludes that, while the medical home is not a “silver bullet,” it can provide a workable foundation piece for overall healthcare transformation. However, to succeed on a large scale, patient-centered medical homes will require significant changes among other key stakeholder, including consumers, clinicians, and health plans, as well as an integrated digital, openly accessible infrastructure to support coordinated care.