Tuesday, September 9, 2008

The Patient Centered Medical Home for Chronic Illness: The DMCB Asks (and Answers) in Health Affairs: Is It Ready for Prime Time?

If you didn’t have enough reasons to subscribe to Health Affairs or regularly check their web site, here’s another: the Disease Management Care Blog has landed a publication in that staid prestigious journal. No longer encumbered by a news embargo, the DMCB sallies forth with the announcement about a “Perspective” piece entitled “The Patient Centered Medical Home for Chronic Illness: Is It Ready for Prime Time?” in the September/October 2008 issue. It’s a response to a very scholarly work by the Urban Institute's Bob Berenson and colleagues appearing in the same issue, who present some interview-backed insights on how physicians and Patient Centered Medical Home (PCMH) advocates agree and sometimes disagree on just what the PCMH will accomplish.

In its article, the DMCB notes the PCMH has great promise but has three challenges to address before the health care system should dive in and begin widespread implementation. They are:

1) Varying definitions of the PCMH across real world clinical settings. Close scrutiny of the underlying literature shows there is a surprising degree of variation in the implementation of the medical home and chronic care model in clinical settings. What’s more, there is little evidence that locating all or some of the elements of the PCMH in the primary care site results in better patient care than, say, letting it reside in managed care or disease management.

2) Limited scalability outside of Medicaid programs, publically funded clinics, pediatric or psychiatry setting or integrated delivery systems. In looking at the literature, experience in implementing the PCMH in smaller physician-owned practice settings is quite limited. The evidence that does exist suggests uptake can vary considerably from clinic to clinic.

3) Scant documentation of cost savings. There is peer-reviewed evidence that many of the individual components of the PCMH may reduce claims expense but there is scant evidence that the PCMH as currently conceived will routinely achieve meaningful savings in commercial insurance programs or in the Medicare program.

Until current and future pilots address these three challenges, the DMCB suggests the answer to the above question is ‘not yet.’

Health Affairs will hold a briefing on the issue on Sept 10, 2008 at 9 AM at the Willard InterContinental. The DMCB was invited to go and it cannot resist. More posts on the topic to follow.

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