Thursday, August 13, 2009

The Optimum Medical Home Or Whatever You Call It: Patients First With Physician Access, E-Care or Phone Care

The Disease Management Care Blog welcomes Chuck Kilo M.D. Dr. Kilo is CEO of GreenField Health, an innovative research and development focused medical group providing comprehensive primary care services. He is also executive director of The Trust for Healthcare Excellence, a not-for-profit organization promoting the collective efforts and conditions necessary for health and healthcare excellence. From 1995 to 2000, Dr. Kilo was a vice president at the Institute for Healthcare Improvement. In 1998 he started the Idealized Design for Clinical Office Practices, which helped create a design foundation for comprehensive primary care services and subsequently what has become known as the Patient-Centered Medical Home. He is on the board of directors for TransforMED and the Foundation for Medical Excellence.

When he writes about the medical home, the DMCB pays close attention.

Comprehensive primary care is about meeting patients' needs when and how they need them to be met. That means offering a spectrum of services, including traditional physician visits as well as e-care or phone care. Thanks to the increasing availability of sophisticated technology, physicians are finding that both the e-care or phone care options are completely feasible today. Since many insurers treat these services as 'non-covered,' getting payment for these services remains a key issue. My clinic provides them for a small annual fee, while other physicians charge patients a direct fee for that service,

This provides ample evidence that when primary care is robust, patients will see it as the preferred location of care and will be willing to personally pay for it. In our experience, patients not only feel very comfortable with a menu of face-to-face visits, e-visits and phone care, but they welcome it. Different people want different levels of these services and our job - no matter what you call it, including a 'medical home, chronic care model or patient centeredness - is to meet those needs.

I advise our primary care colleagues to be less focused on total number of face-to-face visits as a measure of productivity. Rather, physicians need to address the total cost of patient care. If we need to interact with patients more frequently as a mechanism of reducing reliance on more expensive locations of care (such as ERs, urgent care clinics and specialists), then that is appropriate. Even though we obviously don't have direct control over all health care spending, there is good evidence that it can be managed by building strong, trust-based relationships, sending clear messages to patients about how we want and expect them to interact with the healthcare system and making ourselves very available using the technologies described above. What's more, patients can partner with their physicians to financially support this.

Most of the current definitions of "medical homes" have fallen short of this idea. They are limited by a financing system that is focused on the cost or volume of e-care and phone care, not its cost saving potential or patient interest. Fix this and the actual definition of the medical home will fade in importance and health care costs may actually improve.

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