There is a telling absence of breaking news about cost savings, a.k.a. claims expense reductions, a.k.a., bending the curve, a.k.a, return on investment from the medical home pilots. The focus on payment reform, blended capitation/fee-for-service/P4P/shared savings models and an interesting discussion on an alternative approach to reimbursement for measurable outcomes that are 'delegated' to medical homes made the DMCB suspect that the pilots have begun to run into the same issues that plagued early versions of the disease management industry. Hang in there says the DMCB. Not only is the science of cost analytics evolving, so is the patient centered medical home itself, including combined approaches that leverage the best of health information technology, value based insurance and modern versions of disease management. More on that in a later post.
The not-for-profit community health plans, represented by ACHP, also have yet to demonstrate hard savings from their PCMH initiatives, but there are some promising "early indicators." The DMCB also does not blame ACHP or its members for being annoyed at being swept up in the anti-insurer bombast of Ms. Sebelius.
Last but not least, the language of "Patient Centered Medical Homes" may have shifted away from jargon about 'the medical home' to rhetoric about "patient centeredness." This sometimes drifted into a parallel universe of perfectly-practiced medicine, special PCP-patient intimacy, appointments whenever wanted, limitless access to caring specialists and virtuous declines in health care costs. It also included, and the DMCB is not making this up, being a role model for "student-centered schools." The DMCB endorses the concept and votes for commuter-centered DC Metro trains, working wireless-centered wirelessness at last night's cheapo hotel and, as always, DMCB-centered spousing.