Wednesday, December 19, 2012

Going Long on the Patient Centered Medical Home (PCMH) Despite the Prattling Pinheads of Pessimism

Is the Disease Management Care Blog worried about the prognosis of the Patient Centered Medical Home (PCMH)?

Not in the least.

It's simply marching from its "Peak of Inflated Expectations" through the "Trough of Disillusionment." Before you decide to short the PCMH, check out this very enlightening Bloomberg editorial, Lure More Doctors Into Primary Care With 'Medical Homes.'

Noting that many commercial insurers remain committed to the medical home model of careBloomberg's business-savvy editorial board also points out that the PCMH has the added quality of attracting physicians to careers in primary care. The Josia Macy Jr. Foundation has some preliminary data suggesting that experience in medical home settings increases medical students' enthusiasm for primary care.

It's a timely article.  While prattling pinheads of pessimism (examples here and here) glom onto imperfect research methodologies and findings that are unequal to the task at hand, top notch organizations like Sutter, University of Pittsburgh Medical Center and Horizon Blue Cross Blue Shield are going long on the PCMH.

These guys know something that the academics are missing.

Too bad there isn't a PCMH futures market; the DMCB could make some serious money.

Image from Wikipedia


Jeremy Engdahl-Johnson said...

Medical homes face a public awareness problem. The solution? Scenarios that work.

Al Lewis said...

Al Lewis December 26, 2012 at 3:47 am

We could create a futures market — Not only will I take the other side of that bet, but I have aleady offered $50,000 Milliman a bet that an independent panel of biostatisticians would find for me on Communiy Care of North Carolina. Plus my $50,000 includes apologies to them and the state. No takers. CCNC is obviously wrong and they know it –at this point no longer open to dispute — and a couple of the others cited in your links are also clearly wrong on their face.

Like most medical centers who do pop health studies of any kind, Alaska Native Medical Center looked only at the people who had interactions with them in the baseline period, meaning people who were higher-cost in the baseline. This creates regression to the mean exactly as described in my award-winning book, Why Nobody Believes the Numbers.

Read the HealthPartners one more carefully in its entirety. It includes a “350% reduction in waiting time” — you really trust a study by someone who would put that in print?

And Capital’s 40% reduction in admissions? That wipes out all ambulatory care-sensitive admissions for all members, plus all disease management-sensitive admissions for all members, plus a large chunk of admissions that are not considered avoidable.

Call me a prattler, call me a pinhead, call me a pessimist…but if you’d like to take Milliman’s side on the CCNC bet, call me anytime.