Helen Hunt and the Patient Centered Medical Home (PCMH): Making Accountable Care Organizations Want To Be A Better Provider

In the anti-managed care cinematic screed "As Good As It Gets," Jack Nicholson proclaims a famous movie love-line to Helen Hunt: "You make me want to be a better man!" It's an ironic Disease Management Care Blog favorite, and not just because it occasionally shows the DMCB spouse that that statement is not always true. It simply likes the idea that good people can sometimes change dysfunctional behaviors for the better.

Which brings the DMCB to the "Helen Hunt" player in the ACO drama: Patient Centered Medical Homes. Given all the hub-bub over the Republican efforts to appeal the ACA and speculation over the pending ACO regulations, the Disease Management Care Blog began to lose track of the PCMH movement. There are still a lot of state and commercial health plan sponsored pilots out there. What is going on?

Based on the numerous confabs it's attended, the many manuscripts it's read, the many conversations it's had and the many blogs it's scanned, the fate of PCMH appears be increasingly linked to that of ACOs. Not content to wait until there's proof that the PCMH actually "works," policymakers have doubled down by mashing the two concepts together. Unless the majority of stand-alone pilots unexpectedly begin to show some solid results, they'll be completely overshadowed by the ACO feeding frenzy.

Which is why the DMCB suggests that if ACO architects can only read one article about PCMHs that they turn to this past issue of Managed Care Magazine. They will be reminded that the bottom line about the PCMH is that most of the pilots are only two to three years old, which is not enough time to make an informed judgment about whether the PCMH not only merely but sincerely and really reduces health care costs. While there are some success stories (Blue Cross Blue Shield of Michigan, Pennsylvania's Southeast Collaborative and Group Health), there are years to go and lots of hard work ahead before anyone knows for sure.

That being said, the article points out that there are some important features that ACOs will need to keep in mind when they build a healthy primary care medical home capacity, namely:

It's not just the desire to do the right thing as much as paying the primary care docs a lot of money. Repeat: a lot of money.

It's not the electronic health record as much as having a patient data registry to track outcomes. In fact, forcing a full-fledged EHR on primary care clinics can be a distraction.

It's not only a matter of the docs in medical homes working smarter, it's also working harder with extended hours on evenings and weekends.

It's not just the physicians, it's getting the patients involved with written provider-patient agreements.

It's not just the big bang change management in large integrated practices, but finding those practices with six or fewer physicians who can achieve consensus and "just do it."

Why should ACOs go to all this trouble? The DMCB argues that the real reason why ACOs need healthy PCMHs is because of the impact that these primary care practices can have.

There is evidence that greater emphasis on primary care - with or without the wrapper of medical homes - is associated with health care efficiency, quality and effectiveness as well as equitable access and leads to fewer unnecessary ER visits and better coordination. Over and beyond that, however, the DMCB thinks when primary care docs have a credible role, i.e. a "seat at the table." in these emerging mega-organizations, it increases the odds that the ACOs will be better able to reconcile their social mission with profitability.

In other words, even if there is no evidence yet that the PCMH reduces costs, having a strong primary care presence will make ACOs want to be better providers. While that may not do much for the an ACO's bottom line, building a robust primary care network may lead all those angry Helen Hunts out there to buy into the "love line."