Medical homes: A fix for our broken healthcare system

The healthcare system is broken; to fix it we need a new way of thinking about care delivery, healthcare industry experts said Friday at a briefing from the nonpartisan Alliance for Health Reform in the District of Columbia.

The patient-centered medical home (PCMH) offers that opportunity--it's more than just a single program or payment model, Amy Gibson, chief operating officer of the Patient-Centered Primary Care Collaborative said at the event, "Patient-Centered Medical Homes: The Promise and The Reality."

Highlighting our broken system and the need to coordinate care across the continuum, Pauline Lapin, senior advisor at the Center for Medicare and Medicaid Innovation (CMMI), shared her father's experience, a 79-year-old man with six chronic conditions who takes more than 20 medications and vitamins.

Given his medical needs, which involve a range of different providers, Lapin and her sisters decided he should see doctors within one system and co-located in the same building. "What we discovered was no one talks to each other," Lapin said.

While her father has three daughters--a CMMI adviser, a pharmacist and nurse practioner--to coordinate his care, most Medicare beneficiaries aren't that lucky. That's where the PCMH comes in. The PCMH breaks down the silos between providers, hospitals and insurance companies.

One example is the CMMI's Comprehensive Primary Care Initiative (CPC), which fosters collaboration between public and private payers and incentivizes primary care doctors to better coordinate care for their patients. Participating practices must improve their use of data and health IT, as well as provide five comprehensive primary care functions: access and continuity, planned care for chronic conditions and preventive care, risk-stratified care management, patient and caregiver engagement, and coordination of care.

The primary care providers also submit reports on various CPC milestones to demonstrate their processes and progress. For the milestone related to patient experience and engagement, the reports showed that after one year, 100 patient family advisory councils were formed and more than 300 practices regularly survey patients, Lapin noted.

The panelists emphasized that despite sharing goals of better partnerships and connectivity among providers, payers and patients, not all medical homes look alike. "They're caring for populations in different areas of the country, with access to different resources and different skill sets," Gibson said. To evaluate how PCMHs affect cost and quality, it's necessary to have flexible measures to account for those variations, as well as the diverse patient populations served. "It's like comparing apples to oranges," she said.