DMAA: The Care Continuum Alliance added its voice to the advanced medical home model discussion with the release of its paper Advancing the Population Health Improvement Model in December 2007.
DMAA’s statement offers a model with an integrated, physician-guided delivery system with reimbursement for targeted improvement goals for population-based chronic care that mirrors much of what has been backed by physician organizations. (For the list of key components of DMAA’s Population Health Improvement Model, see below.) DMAA’s population health improvement is based on three core components:
1. Central care delivery and leadership roles of the PCP
2. Importance of patient activation, involvement, and personal responsibility
3. Patient focus and expanded care coordination provided by wellness, disease, and chronic care management programs
Gordon Norman, MD, MBA, chair-elect of the DMAA board, a member of the Physician Engagement Committee, which developed the paper, and executive vice president and chief science officer at Alere Medical, Inc., in Reno, NV, says the advanced medical home discussion is an “opportune time to talk about how we can help realize that vision with the learned skills, tools, techniques, and intellectual properties that [DM has] developed in the last 15 years.”
Norman says the paper is not a major change in focus for DMAA. “I think it really codifies a lot of things we have been saying and believing for some period of time but just haven’t been organized and put on paper. For as long as I have been involved in disease management, I think most of us believed physicians, and particularly primary care physicians, are central to our ability to impact population health,” he says.
Norman says DMAA developed the principles to clarify its perspective, open dialogue between the DM industry and others in healthcare, and inform physicians about DM’s potential role in improving care via the advanced medical home.
Norman says the medical home theory is still in the discussion stage and it’s premature to define what will comprise a medical home. He adds the concept will also differ by the locale, type, and size of an organization; community resources; and the patients being served.
“I think that it’s a good thing that we not start with a rigidly defined model but try lots of different formulations and learn which seem to be most suitable under what circumstances,” he says.
One of the reasons the medical home has become such a hot topic is the expected PCP shortage. DMAA’s model promotes group visits, remote patient monitoring, and telehealth, which Norman says could help resolve some of the shortage concerns.
“Under those circumstances, everything we can do to extend the reach and touch of the primary physicians that we have is going to be very important. There are roles that nonphysicians can play in terms of monitoring patients remotely and working with physicians that can multiply their ability to manage a population. I think those will become more prominent,” he says.
One of the sticking points that needs resolution is physician reimbursement for leading care coordination via the medical home.
Norman says PCPs already perform some of those duties but are not being reimbursed. In order for the medical home to become the norm, the physicians will need to get paid for those services.
Although DMAA’s model doesn’t promote a specific reimbursement model, the proposal stipulates the need for increased reimbursements for services.
However, in order for physicians to receive higher reimbursements, Norman says, physicians will have to prove success in clinical process and outcomes indicators, assessment of patient satisfaction, function status and quality of life, economic and care utilization indicators, and effect on known population health disparities.
“There is no free lunch in healthcare in America,” says Norman. “I think the bar will be raised on tracking, measuring, and quantifying outcomes of care far beyond what exists already. That’s a good thing.”
Norman says DMAA’s model is an attempt to show that DM and physicians are complementary partners in population health improvement.
He adds that both sides shouldn’t “get caught up in quibbles over who’s getting what portion of the healthcare premium. It’s really about who is best situated to serve efficiently in a role of population health improvement, and neither of us can succeed, I think, as we might without utilizing the skills, tools, perspectives, and abilities of the other.”
DMAA’s Population Health Improvement Model
The following are the key components of DMAA: The Care Continuum Alliance’s Population Health Improvement Model:
Population identification strategies and processes
Comprehensive needs assessments that assess physical, psychological, economic, and environmental needs
Proactive health promotion programs that increase awareness of the health risks associated with certain personal behaviors and lifestyles
Patient-centric health management goals and educa-tion, which may include primary prevention, behavior modification programs, and support for concordance between the patient and the PCP
Self-management interventions aimed at influencing the targeted population to make behavioral changes
Routine reporting and feedback loops, which may include communications with patients, physicians, health plans, and ancillary providers
Evaluation of clinical, humanistic, and economic outcomes on an ongoing basis with the goal of improving overall population health