Thursday, December 3, 2009

The Patient Centered Medical Homes and Wellness: Can Physicians Really Respond?

Check out this '...but I wouldn't want to live there' posting in the Turn to Stone blog. You might be inclined to dismiss this as another off beat critique of the Patient Centered Medical Home (PCMH), but this one is from Robert Stone. Bob is not only an experienced health care executive with years of experience in population-based care management, he's also a co-founder of the disease management company Healthways. When he speaks, the Disease Management Care Blog has learned to listen.

He raises some good points:
  • 'Wellness' activities such as exercising and pursuing a healthful diet have yet to be intelligently 'medicalized' in any meaningful fashion. Consumers don't look to their local hospitals and doctors for wellness. What's more, hospitals and doctors don't have the resources (and in many instances the knowledge) to provide wellness services. Last but not least, retooling the overwelmed primary care system to adopt wellness in their busy clinics is a stretch.

  • It is doubtful that today's average physician wants to be in the wellness business. After four years of medical school and additional years of postgraduate training, they are trained and socially conditioned to diagnose and treat disease.

Supporters of the PCMH would point out that their care model doesn't rely on the physician personally providing the services. Rather, their job is to be 'doctors' while simultaneously overseeing a team of health professionals that support wellness and prevention. Unfortunately, that key concept may be getting lost as the 'medical home' enters the mainstream. Early buyers of 'medical homes' may be disappointed when they're met at the PCMH door by Nurse Marcia Wellness instead of Doctor Marcus Welby.

The Disease Management Care Blog is more alarmed by Turn to Stone's second point. If docs haven't had a lot of personal professional experience to intelligently deal with nutrition, exercise and all the other forms of non-traditional medical consumerism, how in the world are they supposed to supervise it?

The answer may be to totally 'outsource it.' The DMCB wonders if docs will be inclined to do that and if companies such as Healthways will be able to serve that market.

Time will tell.

1 comment:

Neal Kaufman said...

I think Robert Stone maybe wrong when he said that physicians won’t (or can’t) provide lifestyle and other related counseling. Perhaps his thinking is based on the old paradigm of only providing expensive, in-person or on-the-phone, one-on-one counseling that is so common in many practices to today. Emerging internet and cell phone technologies will allow organized medicine to cost-effectively provide patients with the day-to-day support they need to prevent disease and self-manage their conditions, all integrated into the fabric of the practice of medicine. By building on the benefits of a trusted clinical relationship, clinicians will be able to help their patients get better and obtain longer lasting results than approaches disconnected from healthcare. One example of a technology assisted and clinically-linked behavior change intervention is the transformation of the NIH’s Diabetes Prevention Program to the internet (see Using the Internet to Translate an Evidence-Base Lifestyle Intervention into Practice K.M. McTigue,, Telemedicine and s-Health Vol 15, No 9. Pages 851-858). Programs such as this one are allowing clinicians to play an active in a patient’s behavior change activities at a fraction of the cost of traditional personnel intensive interventions.

In the connected era, effective behavior change interventions have just in time delivery of personalized and up-to-date data and information a person needs to make wise choices. Patients are supported so they can easily and accurately keep track of their performance and use that knowledge to plan and implement new approaches to reaching their goals. They provide tailored messages and experiences that speak to each person, based on their unique characteristics, performance on key behaviors and needs at that moment in time. They help patients link directly to family, friends and colleagues for crucial support, and link to their many healthcare providers to help integrate medical care with everyday life.

As reimbursement policies provide incentives for improved outcomes in chronic disease, more and more healthcare providers will want to help their patient help themselves become more health. Technology will allow clinicians to provide cost effective and engaging behavior change support to many patients, one person at a time.

Neal Kaufman, M.D., M.P.H.
Founder and Chief Executive Officer
DPS Health
1539 Sawtelle Blvd. Suite 10
Los Angeles, CA 90025
(Office) 310.444.0636
(Cell) 310.963.2780
DPS Health is dedicated to enhancing the capacity
of healthcare providers to improve the health of their patients
through research-proven, online self-management support interventions