The current healthcare system is a "graveyard," says Paul Grundy, MD, president of the Patient-Centered Primary Care Collaborative, but he has a roadmap that will take the country to the promised land.
That map, a report titled "Better to Best: Value-Driving Elements of the Patient Centered Medical Home and Accountable Care Organizations," declares the country's best bet to achieve a better healthcare system with high quality patient care and more cost effectiveness is embodied in the patient-centered medical home and accountable care organization models. It lays out how those models can work to save the healthcare system in the United States.
The report is based on a summit of healthcare industry, business, consumer group, academic, and policy leaders. The invitation-only summit, which took place last fall in Washington, D.C., was hosted by the PCPCC, a coalition of more than 700 employers, consumer groups, primary care physician representatives and other stakeholders, and sponsored by the Dartmouth Institute for Health Policy and Clinical Practice.
The group's roadmap is based on the PCMH and ACO models because, explains the report's introduction, "The patient centered medical home (PCMH) emphasizes the central role of primary care and care coordination, with the vision that every person should have the opportunity to easily access high quality primary care in a place that is familiar and knowledgeable about their health care needs and choices. The accountable care organization (ACO), also coined the 'medical neighborhood,' emphasizes the urgent need to think beyond patients to populations, providing a vision for increased accountability for performance and spending across the health care system."
The group agreed on four core, "value-driving" elements to its roadmap: enhanced access, care coordination, health information technology and payment reform. The first two maximize health outcomes to lower costs and the last two are tools that the new healthcare delivery models need in order to succeed.
Some of the highlights in each of these categories include:
- Primary care providers need to offer off-hours coverage so that their patients do not end up in the emergency department, an expensive and often unnecessary alternative, or consulting with a different clinician, which leads to fragmentation of care.
- Appointments with a patient's personal clinician provide continuity of care resulting in more patient satisfaction, higher rates of preventative screenings and immunizations and fewer hospital and ER visits.
- Electronic access to medical records and electronic communication between patients and their doctors is necessary in a world where most people have 24/7 electronic access to everything from their bank accounts to shopping.
- Care coordination that improves health outcomes and reduces hospitalizations, readmissions and costs.
- Integration of health IT solutions that enable better access, care coordination and payment reform.
- Payment reform overhaul that includes a demonstrated return on investment, simple changes and evaluation of the new models.
Over the years, many solutions for managing the country's healthcare system have been offered with varying degrees of success, but this one is different, says Cyndy Nayer, president and chief executive officer of the Center for Health Value Innovation, a St. Louis-based nonprofit advocating health quality through value-based design. "This is the first time that we've seen an actual model for how the different market segments will collaborate," she says.
[See related stories: AHA issues report on PCMHs; CIGNA says ACO pilots lower costs]
But, she cautions, just because the roadmap on the whole is solid doesn't mean that it's complete. "The devil is in the details," she says.
Things that will have to be faced, she thinks, include navigating the tensions between hospitals and doctors, building accountability at the patient level and getting the technology right, so that, for example, one hospital's electronic medical records system will be compatible with another's even if they're different systems.
Grundy characterizes himself as "pumped" by the roadmap created by the consensus team, of which he was a part. He believes that map will stick because so many organizations from a range of sectors have agreed to it. But more than anything, he says, it'll stick because the country is at a point where it has to do something.
"We've reached an end point on cost affordability on episodic, disintegrated, uncoordinated, inaccessible care," he says. "We can no longer afford to spend twice as much as any other nation on the face of the earth for a value proposition that's lower than any other."
He also thinks that unlike earlier propositions, this one has the data to support it since PCMH and ACO pilots have been taking place across the country, and consumers – governments, businesses, employers and individuals – are demanding it, including his own employer, IBM, where he is the global director of healthcare transformation.
"You've got consumers that are used to – that grew up – being able to access their data 24/7 and they're not going to tolerate not being able to do their healthcare [the same way]," he points out.
"I agree that there will always be push back to the status quo," he says. "That always happens, right? That's nothing new. That's any time change occurs. But we've passed the tipping point. It's over. It's done."