Those of you who follow me on twitter may know that I traveled to Washington DC late last week to take part in a "roundtable event" discussing paths to better diabetes care. Now, I'm no policy-maker, and certainly no expert on the crazy mixed-up reimbursement system in this country. I was there, again, to talk about what's wrong with the way most diabetes patients are treated now, and what's needed to make it better.
Once again, my bit was a call for better coordination of care ("healthcare team," my ear!) and providing patients the education and ongoing coaching they so desperately need. We talked a lot about how all the new web-based health tools (Health 2.0 stuff) might be employed by patients and their doctors together to actually help patients do better in real life (remember that, Doc?)
The most eye-opening thing to me about this meeting was learning about the so-called "Patient Centered Medical Home."
I'd heard the term many times before, and admittedly, paid little attention because I assumed it had to do with home-based healthcare for the elderly. Actually, it's a movement — a sweeping initiative to improve medical care in this country by creating all-inclusive clinics where primary care docs not only offer preventive health counseling, screenings and immunizations, but also provide "care advocacy" with patients and family members, and coordinate care with on-site specialists — all at incredibly reasonable prices. These wonder-clinics would become the patient's "medical home."
Check out this list of guiding principles:
• Personal physician: "each patient has an ongoing relationship with a personal physician trained to provide first contact, continuous and comprehensive care."
• Physician directed medical practice: "the personal physician leads a team of individuals at the practice level who collectively take responsibility for the ongoing care of patients."
• Whole person orientation: "the personal physician is responsible for providing for all the patient's health care needs or taking responsibility for appropriately arranging care with other qualified professionals."
• Care is coordinated and/or integrated, for example across specialists, hospitals, home health agencies, and nursing homes.
• Quality and safety are assured by a care planning process, evidence-based medicine, clinical decision-support tools, performance measurement, active participation of patients in decision-making, information technology, a voluntary recognition process, quality improvement activities, and other measures.
• Enhanced access to care is available (e.g., via "open scheduling, expanded hours and new options for communication").
• Payment must "appropriately recognize[s] the added value provided to patients who have a patient-centered medical home." For instance, payment should reflect the value of "work that falls outside of the face-to-face visit," should "support adoption and use of health information technology for quality improvement," and should "recognize case mix differences in the patient population being treated within the practice."
Sound too good to be true? Sure does to me. But it's actually happening at dozens of pilot sites around the country, according to the Patient-Centered Primary Care Collaborative, a huge national collaborative whose executive director took part in the roundtable event.
The PCPCC was founded by IBM in 2005, and is backed by some 500 large employers, insurers, consumer groups, and doctors, including the American College of Physicians and the Academy of Family Physicians (who knew?)
Sounds like we all should be enjoying this "new model of care" by now, but we're not. In fact, I never met a single person who is... I guess you have to be lucky enough to be in the right place with the right employer (story of our lives, ay?)
Surveying the blogosphere, I noticed there's some institutional discord about how to evaluate the Medical Home sites that are up and running, i.e. the authorities seem to be using old data-based methods for reviews, rather than asking patients directly about their experiences (not a good sign).
So here is my question: Do any of you PWDs out there have experience in a Patient-Centered Medical Home environment?
Is it really as amazing as it sounds? Or is this mainly a lot of lip-service over some slightly-more-coordinated clinics than we're used to?