Parks Associates Blog

Tuesday, October 28, 2008

The Medical Home Debate--My Symposium Experience (1)

I am currently attending Partners Healthcare’s Symposium event held in Boston, MA. On Monday morning, I moderated a panel on the topic of the emerging medical home model. The four panelists are George Chadraoui from IBM, David Hom from David Hom LLC, Vince Kuraitis from Better Health Technologies, and Ediwna Rogers from the Patient Center Primary Care Collaborative (PCPCC). This is an extremely important topic as the medical home model could be a disruptive force in the healthcare ecosystem, and influence technology adoption and usage.

The panel from the beginning tried to define the medical home model. But as the discussion and interaction with the audience furthered, it became clear that primary care physicians may not be the only one that are driving it and therefore benefit from it. Vince Kuraitis challenged the notion that traditional disease management firms might be left out of the model, several members from the audience raised the concept of “virtual medical home” in which through the Internet and other technologies, consumers can choose the trusted parties, including specialists, nurses, pharmacists, and dieticians, to help coordinate their care needs and provide health coaching when necessary.

I polled the audience to gauge their perceptions of the medical home concept. About 40% of them raise their hands showing their confidence in this model. A dozen expressed deep doubt, and the rest, I assume, remained lukewarm or undecided. Among those with deep concerns, the center issue is about execution. One lady doubted physicians would have enough resources. Another raised the issue of the disruption on physicians’ workflow. In a word, “the devil is in the details” and perhaps “seeing is believing.”

The other three panelists had positive views about primary care physician’s role in driving the adoption of the medical model. George cited support from employers like his own company IBM, Edwina provided further details on trials supported by PCPCC to prove that the model had worked. She particularly mentioned the North Carolina Community trial in which each PCP receive a payment arrangement of $2.5 per patient per month to implement the medical home model. In the future, she said that the Medicare/Medicaid is willing to pay $40-$100 PMPM in their proposed trials. Vince’s view perhaps represented the majority in the room. The model has potential, but implementation will be the key to success as there are too many variations in this country’s physician practices and small factors could contribute to fallouts. Sounds familiar? It kind of reminds me of the early days of the disease management industry.

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