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Physicians need DM in medical home model

Collaborative effort between docs, industry expected

There are signs that the advanced medical home concept is gaining steam: The increasing drumbeat emanating from physician groups, the reported success of Medicare’s Physician Group Practice (PGP) demonstration projects, and two documents released in December 2007 that noted the benefits of having PCPs at the center of patient care. “People are realizing that if you are going to have any way of controlling the costs of healthcare and costs of premiums for people, we have to find effective ways to treat chronic illnesses,” says David S. Herr, MD, chief medical officer at Rocky Mountain Health Plans in Grand Junction, CO. “This is really a win-win approach. You are promoting the idea of more care for your patients, not limiting care. You’re giving the care when it’s most effective, and with a healthier patient, you’re avoiding a higher hospital cost later.”

The two documents released in December that promoted the medical home model are:

1. DMAA: The Care Continuum Alliance’s Advancing the Population Health Improvement Model, which supports a system in which the patient-physician relationship is at the center of a “comprehensive, coordinated team approach.”

2. The Commonwealth Fund’s report Bending the Curve: Options for Achieving Savings and Improving Value in U.S. Health Spending, which highlights several cost-saving ideas and notes that a medical home with “a per-member per-month fee for care management services in addition to usual fee-for-service payments” and “additional quality- and efficiency-based incentives” could save $60 billion in five years and $193.5 billion in 10 years in national health expenditures. Most of the savings would come from a decrease in hospital and physician expenses resulting from “higher-quality and more-efficient care delivered by medical homes.”

The medical home movement is full steam ahead, which makes one wonder: What will happen to the DM industry if the medical home concept becomes the norm?

DM leaders say the medical home does not signal the end of DM companies, but instead DM will play a major role in the concept.

The advanced medical home concept with care coordination in the physician’s practices is quite a different model than DM, but Gordon Norman, MD, MBA, chair-elect of DMAA and executive vice president and chief science officer at Alere Medical, Inc., in Reno, NV, says the medical home is not a substitute for the DM industry; rather, DM is a complementary tool that physicians will need.

“DM has about a 15-year learning curve of developing techniques for improving population health that is not going to be learned or adopted overnight by primary care physicians,” says Norman, who describes his vision of the medical home this way: care coordination services funneling through a single focus and point of contact (the physician) so the patient doesn’t have to become a healthcare expert to chase down all the information from separate sources.

Vince Kuraitis, JD, MBA, principal of Better Health Technologies in Boise, ID, says the medical home model has the potential to become “a blending of the best of both worlds” that will include doctors properly reimbursed for care coordination that is supported by DM’s infrastructure, such as call centers, predictive modeling software, diabetes educators, and remote monitoring.

Rick Kellerman, MD, board chair of the American Academy of Family Physicians and a practicing family physician in Wichita, KS, says DM and PCPs working in “parallel universes” is a “waste of money.”

The patient-centered medical home is supported by physician organizations, such as the American Academy of Family Physicians, American Academy of Pediatrics, American College of Physicians, and American Osteopathic Association. The four groups released a joint statement in support of the concept in March 2007 that described care in the medical home this way:

The patient is in control of care with a strong ongoing relationship with the PCP

The physician oversees a team of individuals who collectively care for the patient

Care coordination allows the patient to receive the proper care when it is needed

“We know many patients change behaviors just on the recommendation of their physician,” says Kellerman. “There’s great value in having a physician who provides most of the care that most of the patients need most of the time and helps coordinate and integrate their care across the healthcare system when they go to the hospital or see a consultant. Having that integration function is important and improves quality and controls costs.”

A common complaint among physicians is that DM companies do not communicate with them. Kellerman says greater communication is needed in the medical home. “We’re all going to have to align in terms of helping patients manage their own illnesses,” he says.

Although pediatricians have been talking about the medical home idea since the 1960s, particularly for children with severe disabilities, new technology that allows for greater care coordination is making DM interested in the medical home model.

Ariel Linden, DrPH, MS, president of Linden Consulting Group in Hillsboro, OR, says a new chronic care model via the medical home concept could actually benefit DM. With the physician in control of managing chronically ill patients, DM won’t have to prove ROI.

“There are some very positive benefits for the disease management industry,” says Linden. “First of all, it gets away from the ROI argument. [In the medical home model, DM companies] would no longer be on the hook for that. They are there to support the physician. If the physician can manage patients better and keep people out of the hospital, they will benefit financially from the payer. That said, the program fees will have to be low enough to entice a physician to use these services.”

Kellerman says the medical home is needed because the country’s healthcare system is “behind the eight ball.” He likened attempting to change healthcare to trying to turn the Titanic.

“The baby boomers are starting to retire, there’s more chronic disease, costs are out of control, we’re in a global environment, there are so many reasons to change the system, and yet there is incredible inertia that prevents change,” he says. “Inertia is the major barrier.”