The Patient-Centered Medical Home — A Path to Lower Costs and Better Health Outcomes
At the end of 2007, I wrote a post discussing how a recent report that we at the Primary Care Development Corporation authored showed that the primary care system--the backbone of our healthcare infrastructure--had reached crisis levels. We had discovered that, at least for low income patients, every primary care provider initially loses money on every single visit by a patient. As a result, they are forced to scramble to fill these deficits with public and/or private grants or other revenues.
Thus the system, already weak, is at risk of complete collapse in many communities, threatening both our fiscal and medical future in New York State.
However, there is a bright side to our study. We propose a new model of primary care capable of reducing overall health care costs while improving health outcomes. The model is known as the Patient-Centered Medical Home and is gaining widespread support from both physicians and health care policy experts. It is viewed as a keystone policy change that is absolutely necessary for the solvency and viability of our primary care system.
A patient-centered medical home emphasizes primary and preventive care in achieving better outcomes and using resources more efficiently. It creates an ongoing relationship between a patient and a personal provider trained to provide first contact, continuous and comprehensive care. And it is organized into patient care teams that work in partnership with the patient and take responsibility for the ongoing, total care of the patient, including coordination across care settings (e.g. specialists, laboratories, x-ray facilities, hospitals, home care agencies, etc.) And it removes traditional barriers to access, such as long waiting times.
So why isn’t this model followed by health care providers? While it requires radical change, the overwhelming reason comes down to money. Both commercial insurers and Medicaid (along with most other insurance options) do not pay physicians for providing this kind of service.
To make the patient-centered medical home financially feasible, Albany must take action to change the structure of our reimbursement system for health care. As usual, health care looms large as one of the major battles in this year’s legislative session. But unless action is taken to change the nature of our reimbursement system for primary care, the entire health care system faces financial and medical peril.