Healthcare is notorious for trying out solutions that seem to work in theory, only to watch them collapse in practice. Like
throwing spaghetti at the wall, players from all segments have experimented, looking for new ideas that might stick.
Getty Images / Dimitri Vervitsiotis
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The most recent concept that is showing real sticking power is the patient-centered medical home.
Since 2006, more than 30 states have initiated projects to apply the medical-home concept to Medicaid and Children's Health
Insurance Programs. Reduced costs, better support for chronic care and improved population health are the impetus behind the
local efforts, which comprehensively hold the potential to effect system change, piece by piece.
Although no two projects are identical, all reflect core principles of aligning reimbursement, supporting primary-care practices,
measuring results and scaling the model beyond an initial pilot phase. Early results have shown promise, which is inspiring
more payers and providers to adopt the model. The general arrangement of a team of clinicians providing a home base of individualized, coordinated care and prevention emerged
through the American Academy of Pediatrics in the 1960s for specific pediatric populations. It wasn't until recent years—as
the industry began to focus more on healthcare value—that the medical-home idea was identified as a potential formula for
improvement of service delivery within broader primary care practice.
In 2007, four major physician groups defined a set of joint principles to describe a patient-centered medical home, which
was soon followed by the creation of the Patient-Centered Primary Care Collaborative (PCPCC), which represents employers,
plans, providers and other organizations that endorse the principles. The National Committee for Quality Assurance (NCQA)
is currently in the process of updating standards for its medical-home recognition program, which were initially released
in January 2008.
Policymakers and the healthcare industry continue to assess the local projects, anxious to determine their financial worth
and their promise for large-scale implementation.
MANAGED HEALTHCARE EXECUTIVE recently brought together a roundtable of executive thought leaders to discuss the issues related
to patient-centered medical homes. The panel includes:
- Paul Grundy, MD, chairman of the Patient-Centered Primary Care Collaborative and director of healthcare technology and strategic initiatives
at IBM;
- Lori Heim, MD, president, American Academy of Family Physicians;
- Len Nichols, economist, New America Foundation;
- Jerry Salkowe, MD, vice president of clinical quality improvement, MVP Healthcare; and
- C. Edwin Webb, PharmD, associate executive director, American College of Clinical Pharmacy
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