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.