Monday, March 2, 2009

Learning Snippets from the National Medical Home Summit

The Disease Management Care Blog spent the afternoon in Philadelphia basking at the National Medical Home Summit. It may have been a Nor'easter blustery winter wonderland outside but inside, the learning warmed the heart of the DMCB and lit up all kinds of lightbulbs.

Here's some highlights from some of the luminary speakers:

Nancy Johnson, former Congresswoman: Don't expect healthcare reform including the words 'Medical Home' this year. That's not a bad thing, because we're on a learning curve and policy rushed into law can be overly prescriptive and punitive. Next biggest opportunity for the Medical Home: addressing end-of-life care. Interesting quote: if we don't get this right, we'll end up with a single payer system that is just like Medicaid.

Paul Keckley, of Deloitte: The term 'Medical Home' has bad connotations for health care consumers because it sounds so....institutional. 'Primary Care 2.0' sounds better, especially because it - along with Retail Clinics, Disease Management in Retail Pharmacies and Home-Based Connected Care - has to potential to be a cheaper and better disruptive technology that promises to upend care as we know it. Interesting quote: primary care physicians not only deserve $275,000 a year in income, pretending otherwise makes policy makers suspect there is some sort of hidden agenda.

Meredith Rosenthal, of Harvard: Expect the Medical Home to eventually be reimbursed with some combination of fee-for-service, capitation, pay for performance and upside risk sharing, possibly tied to incentives to invest in the primary care site's infrastructure. Unfortunately, we're not there yet with the payment models that work best: we need more time. Interesting quote: the greatest opportunities for the Medical Home may be in reducing duplicative tests and promoting referrals to efficient specialists.

Phyllis Torda, of the NCQA: Having NCQA recognition as a Medical Home correlates with clinical performance in diabetes care and cardiovascular disease. Expect the standards to be updated in 2010 (DMCB comment: they're not going to be easier, so if a primary care site is thinking about this, now is the time). Interesting quote: we need to engage the specialist physicians in a 'neighborhood' around the Medical Home.

Linda Magno of CMS: The Medical Home Demo is ready to go, and no, she's not going to spill any details until the Office of Management & Budget says it's OK to spill the details and no, she's not telling when that is going to happen. Interesting quote: Just because Medicare has two Medical Home levels and the NCQA has three doesn't mean that future Medicare iterations won't reflect the NCQA approach.

Lisa Letourneau of Maine's Quality Counts: Maine has it's own multi-stakeholder Patient Centered Medical Home demo underway, but this one really has put the patient in the center, including having two lay persons participate in designing initiative and the ongoing evaluation of the outcomes. Interesting quote: none, but the DMCB wondered why there isn't a majority of laypersons in the evaluation process.

Gordon Norman of Alere: Success for the Medical Home may be less dependent on "savings" and more on demonstrating some cost mitigation and value. Interesting quote: if we're not careful, demos involving the PCMH will lose the foot race for the hearts and minds of primary care physicians. Even if value is shown, there may be no one to turn on the lights in the primary care clinics.

Paul Wallace of Kaiser: Medical Homes need data including utilization information, admission rates and specialist efficiencies. Interesting quote: If we don't do everything to help Medical Homes succeed, we'll kill off the last PCP.

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