A recent article in Fortune magazine describes how “medical homes” – described as a “common sense” ground-up improvement in health care delivery – can save states hundreds of millions of dollars in health care costs. In Illinois alone, the 2009 total of savings in state-funded health care costs was around $140 million.
The Patient Centered Medical Home model has been promoted for a number of years by many prestigious organizations, including the American Academy of Pediatrics, the American Academy of Family Practice, and the American College of Physicians. These models include details about payment methodologies, care coordination and usage of technology – things that seem “new” in health care modernspeak, but actually represent a re-embracing of traditional health care values: you know who your doctor is, you go there for preventive care, you take care of problems while they are small before they turn into massive (expensive) Emergency Room rescue interventions, you engage and participate with your doctor in order to navigate the otherwise-overwhelming health care ecosystem. In other words, “common sense.”
On a high level, this all seems like the right direction to head. However, implementing such a change is fairly complex, especially in the private-practicing small-group and solo practice setting, where much of the bulk of health care is delivered in this country. Many of the settings where Medical Home approaches have been implemented have been clinics – large multi-specialty clinics and community or public-sector clinics. Such clinics are able to gather compensation from payors (fee-for-service, or per-member-per-month capitation, or whatever other mechanism can be leveraged) and then compensate clinicians internally according to a different, performance-based mechanism. Small practices, on the other hand, are much more at the mercy of payment methodologies carried out by external payors.
A practice can actually become designated as an “official” Medical Home in order to be eligible to participate in various local and federal pilots. The Patient-Centered Primary Care Collaborative is one resource physicians can use to access these new alternative payment strategies, which are felt by many to be the way of “rescuing” primary care, and turn the downward trend of primary care manpower depletion around. Other organizations, such as DocSite, also help practices gear-up to quality as designated Medical Homes.
In order for a practice to be eligible for Medical Home designation, it must (1) Be compensated for the time and effort required to manage their patients health, including time spent responding to urgent and non-urgent health care concerns, (2) Adopt a strategic approach to guiding patient care both for the individual patient and entire groups of patients; (3) Truly manage the patient’s health in a holistic manner; not just deal with problems presented today but proactively address the patient’s entire well-being (4) Use evidence-based guidelines to coordinate and track patient needs (5) Provide a team approach to care delivered within their clinical practice; and (6) Employ patient and population management tools that clinically support their practice without disrupting efficiency
It is basically inconceivable to be able to achieve these goals without having implemented an Electronic Health Records (EHR) system. Given the steep costs and workflow disruptions involved with most traditional EHRs, it is small wonder that Medical Homes have basically been designated among larger clinics and institutional settings. However, web-based, free systems (e.g. Practice Fusion) have enjoyed widespread popularity among smaller practice settings. What this means is that the advanced tools needed to achieve Medical Home designation are now becoming available to the smaller practice settings, and EHR cost is no longer the barrier it once was.
Of course, there is more to the Medical Home than simply having and using an EHR. It involves a change in orientation from the one fostered by years of fee-for-service-oriented thinking, and the adversarial payment-justification relationship between providers and payors of medical service. Federal policy may help this. A change in the orientation of private health plans may help this. The Patient Protection and Affordable Care Act may help this. But the platform – the tools – needed in order to carry out this fundamental change in the health care culture absolutely require the meaningful use of an EHR.
Robert Rowley, MD
Chief Medical Officer
Practice Fusion EMR
