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Americans Want a Home

Les Masterson, for HealthLeaders Media, August 13, 2008

A growing number of Americans are so disgusted by the state of healthcare that they are willing to tear down the system and start anew. Studies show that Americans want a new healthcare system in which a provider coordinates a patient's care and in which physicians, pharmacists, therapists, and other healthcare providers communicate on a secure computer platform.

Americans may not know the phrase "medical home," but that is what they are describing. They want a medical home because they have seen how a lack of coordinated care affects them. They don't understand why they have to fill out medical and family history forms at each doctor's offices, why their doctors don't communicate with one another, or why their physicians request duplicate tests because one doctor doesn't know what another is doing.

The concept is being tested in pilots throughout the U.S., and the Centers for Medicare and Medicaid Services is planning a demonstration project in 2010. For those struggling with the healthcare system, these far-off dates are not comforting. They want better care coordination now. Rather than wait to follow CMS' lead, there are health insurers who are funding medical home-inspired programs. Progress has been slow and more players are needed to make the medical home more than a movement.

Here are four ways healthcare leaders can jumpstart greater care coordination:

  1. What's needed first is a groundswell. For this reason, providers must demand better care coordination. There are groups working on promoting the medical home, including The Patient-Centered Primary Care Collaborative. Physicians need to join forces and reach out to other healthcare stakeholders so a legion of leaders can advocate these kinds of care improvements. Once that collaboration is accomplished, they need to reach out to the payers. Healthcare is so stuck in its silos that physicians might not realize that payers agree that care coordination is needed. Care coordination is not just a patient care issue, but could ultimately improve physician payments as a number of payers have implemented pay for performance programs through care coordination.
  2. The next step is for payers to test the medical home by offering grants to create technology platforms that allow for greater communication across networks. This is happening in small pockets of the country, such as Massachusetts' eHealth Collaborative (funded through a $50 million commitment from Blue Cross Blue Shield of Massachusetts) and Rocky Mountain Health Plan's medical home program. Better technology isn't just a communication or convenience issue, but affects quality of care and costs.
  3. Payers must develop programs that adequately pay providers for spearheading this kind of care coordination. To truly create a medical home, physicians will need to implement technology, hire staff, and coordinate the patient's care. They are not going to welcome a new venture as large as the medical home without payers stepping to the plate.
  4. Once those pilots are completed, researchers must conduct objective studies to see which programs lower costs, improve outcomes, and provide for care coordination, and which ones do not.

Most agree the current healthcare system is not working properly. It doesn't make sense to continue to pump money into a flawed system and get the same results. A better alternative for health insurers is to improve processes, through concepts like the medical home.

As The Commonwealth Fund study shows, the healthcare-paying public is not happy with the services provided. Are you going to answer your customers' requests or wait until the government legislates wide-ranging changes to the healthcare system?


Les Masterson is senior editor of Health Plan Insider. He can be reached at lmasterson@healthleadersmedia.com .


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