One of the most rewarding aspects of being a healthcare administrator is having the opportunity to watch committed doctors and other providers interact around improving the care of patients. Over the years, this has usually been in the context of discussing the care being provided to individual patients during of rounds in the Intensive Care Unit or discussion of patients in the Cancer Tumor Board. In this context, the only focus is the patient, and the different disciplines bring their perspective on how an individual patient should be treated. I feel particular pride on these occasions because I experience the knowledge and dedication of wonderful healthcare providers being brought to bear on determining the best care for an individual patient. During those moments, all the administrative and process issues that occupy much of my time seem to vanish. It’s all about the patient.
Recently I’ve had the opportunity to observe a similarly dedicated group of health professionals, mostly primary care physicians and healthcare policy makers, grappling with the issue of how you improve care and affordability on a macro basis—for the population of a state. The Executive Committee of the Chronic Care Sustainability Initiative (CSI), which is actually the Patient Centered Medical Home project in Rhode Island, is reviewing the available evidence to determine how patient centered medical home (PCMH) practices in other states have affected measureable health outcomes and the cost of care.
We are fortunate to have a group of incredibly smart and dedicated providers and policy makers in our state leading the transformation of primary care.
As with traditional research studies to determine the efficacy of treatment interventions, such as new drugs, there are many variables to deal with in assessing the effectiveness of PCMH practices, and the pilot projects are different in each state. Although almost all the pilot projects require that practices be recognized as Patient Centered Medical Homes by the National Committee on Quality Assurance, we know there is still wide variability in how they function. In addition, it is difficult to control for the differences in patient populations and the relation of the practice to other resources in the community, such as hospitals. Some practices are part of an integrated system with hospitals and other community health providers, while others are stand-alone practices whose patients use various hospitals.
Despite the difficulty in controlling for all these variables, there is mounting evidence that Patient Centered Medical Home practices improve outcomes for patients, particularly those with chronic conditions; these practices reduce costs by reducing expensive emergency visits and hospitalization; and the patient and provider’s experience of care is enhanced. A recent study entitled “Impact of Medical Homes on Quality, Healthcare Utilization, and Costs,” in The American Journal of Managed Care, compared a large cohort of insured patients in PCMH practices and non-PCMH practices and found significant differences in all three categories. Other insurers have reported similar findings and many are investing in pilot programs around the country.
As a friend whose opinion I greatly respect pointed out, the PCMH movement is not the sole answer to obtaining greater value for our healthcare dollar, but I believe it is a very important component. We are fortunate to have a group of incredibly smart and dedicated providers and policy makers in our state leading the transformation of primary care. Their efforts may ultimately transform the entire healthcare system in our state. In my forty-five years in healthcare, I don’t think I’ve seen the same focus and energy to find solutions, which energizes me to want to be a part of that change.
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