The Medical Home News Question: The DMCB Answers "Other."

The Disease Management Care Blog is happy to serve on the National Advisory Board of Medical Home News.  MHN has important insights and updates on the implementation of Patient Centered Medical Home (PCMH).  It also regularly poises a "Thought Leader's Corner"question and prints answers from the PCMH community.

The December '12 issue question was:

What is the single most important issue to overcome in terms of widespread implementation of the medical home model?
A growing shortage of PCPs?
Lack of payer commitment to reimburse care coordination?
Lack of incentives to adopt/implement EHRs?
Lack of sufficient team culture being taught?
Other?

The Disease Management Care Blog naturally answered "other...."

"While I used to think the most important issue was finding generalizable approach to care (template) and an accompanying business model that has consistently been shown to reduce health care costs in a clinically and statistically significant manner, I’m changing my mind. 

The most important issue is the emerging link between accountable care organizations and the medical home to the exclusion of all other approaches to care.  The medical home has had its victories, but much of the published high quality research is from highly integrated settings and even then, it’s unclear if the avoided claims expense is greater than all the indirect and direct costs. We still don’t know if the medical home can succeed in the other kinds of networks being established by ACOs. 

As a result, if ACOs stumble and prove to be an unsuccessful reprise of the 1990s style physician-hospital initiatives, the medical home could be taken down before we know if it can work in non-academic, non-Medicaid community settings. 

This promising baby could be thrown out with the bathwater."

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