Thursday, May 15, 2008

The Medical Home: More Time, More Patients or More Money. Or More Money Not.

A long time ago, a very wise managed care executive told the Disease Management Care Blog that there are only three things you can give physicians. They are more time, more patients or more money. This trinity may be part of the overlapping three-way theoretical appeal of the 'Medical Home.' An IT-supported, clinic-based care team and a forward thinking health insurer could render up all three.

By (appropriately) transferring some clinical responsibilities to non-physicians, there'd theoretically be more time in the day. That could mean higher quality, longer visits per patient, or the physician could go home a bit earlier for a change. The time could also be used to coordinate care for patients with chronic illness.

Or, that time could alternatively be used to accomodate more patients in the practice. With or without the extra time, seeing patients is what doctors 'do,' and while many primary care physicians are overburdened, many others would still welcome the chance to grow their clinical practices. Efficient practices with the Medical Home could attract more patients - with or without chronic illness.

Finally, more time and/or more patients means more cash flow. Even without the additional time or patients, physicians would also welcome a higher fee per patient. Proposals on financing the Medical Home center around an additional monthly payment in addition to the usual fee-for service.

Yet, all is not well in the money part of this trinity. The DMCB recommends you check out Vince Kuraitis' excellent post (with a promise of more to come) on how the toxic waste of traditional medical payment methodology is threatening to engulf the Medical Home.

As an aside, you may want to also review this article in the Philadelphia Inquirer. It quotes $13 million for 220,000 patients. Sounds like a lot of money, but if you do the math, it's not a lot per patient.

As a supporter of 'disease management,' I'm worried that underfunding of the Medical Home will doom it. In my humble opinion, the Medical Home will turn out to be a key component of future population-based health care solutions for patients with chronic illness. My colleagues in the disease management industry agree with me: if this promising if unproven approach to care suffers a crib death, it'll be a tragedy.

No comments: