Disease Management and the Medical Home Podcast

The Disease Management Care Blog is in a podcast? That DMCB first is thanks to the DMAA posting the audio from a November 25 keynote panel held at the Hollywood Florida Forum 08 Meeting. The topic was a DMCB favorite: the patient centered medical home and disease management. Hundreds listened in on the presentation and this is your chance to share in the knowledge.

The link to the audio is here. In it, you'll hear the real stars of the show, Lisa Latts MD of WellPoint, Paul Wallace MD of Kaiser Permanente and Ricardo Guggenheim MD of McKesson. These experts know of which they speak. So, if you must eat your lunch at your desk, the DMCB suggests listening to this will make your left-over turkey, lettuce n' mayo sandwich that much tastier.

A summary prepared by the DMAA eNews is below in case you don't have the time to listen right now.

'The panelists generally expressed optimism about the medical home model, but cautioned that questions remain about the fundamental design, payment mechanisms and patient engagement strategies. Dr. Wallace suggested that the patient-centered medical home might be better positioned as one component of a more complex "medical neighborhood" with a diversity of providers and a care delivery infrastructure supported, in part, by population health improvement. He also argued for greater patient involvement in health care decision making as the best path to a successful medical home. "Patient-centeredness is something we can do," he said of physicians. But "'personalized' is something that we can only do together with the patient. I think we have to trust the patient to help us find that spot." Dr. Guggenheim noted the need to include hospitals in the "medical neighborhood" concept. Success, he stated, will depend on the ability of the population health improvement industry to provide actionable, real-time data; IT tools to facilitate the care management process; and consumer-focused service.

Dr. Latts noted the challenge of providing additional payment to primary care physicians for medical home services with a limited pot of money that also must fund specialty care. She emphasized that, to succeed, the medical home must be simple to administer for primary care practices, with a coordinated approach to working with multiple vendors, including those providing population health improvement services. Dr. Guggenheim also spoke about the challenge of finding an acceptable payment model for the medical home, calling it "the biggest hurdle" to change. "I think the biggest problem that you have with changes in payment structure is that everyone wants them but nobody's that eager to sign up for them," he said.

Dr. Wallace said that payment reform is achievable, but must include "some accountability in the process for what patients care about." Patients, he said, "care about cost, they care about service and they also care about health. And I think that that's really the dilemma about how we align that incentive. I think that's where managed care and we came up short in the '90s." He also said the medical home must encourage the primary care provider to serve as a gateway to appropriate specialty care rather than as a gatekeeper to limit access to specialists.

Dr. Wallace sounded a positive note for population health, saying that the industry's expertise in reaching out to patients will underscore its value in a care delivery model centered on patients' needs. "I think that's why I'm hopeful for this industry, because this industry has survived only because it has figured out how to connect with patients," he said. "The challenge here is how do we take that connection with patients and align it with the rest of the delivery system?"'

Coda: Next year's meeting Forum '09 Sept 20-23 in San Diego. Mark your calendar.