Thursday, July 05, 2012
For those who are interested . . .
This editorial in JAMA helps clarify the concept of the Patient Centered Medical Home and its relationship to Accountable Care Organizations. I don't have much to add to it except to tease out one important problem.
It has been shown that the PCMH model can indeed reduce overall health care costs by avoiding unnecessary hospitalizations and ER visits. The problem is, the PCMH -- which is essentially a primary care practice -- doesn't capture any of those savings. But, it costs slightly more per patient to be a PCMH.
Remember that the PCMH is a model of health services delivery based in primary care practice; whereas the ACO is a model for paying for medical care. The financial relationship between the PCMH, and hospital and specialty services is generally unspecified. The ideal is that they be included within the same ACO and that the ACO allocate sufficient funds to the PCMH to support it in successfully reducing hospitalizations, ER visits and other specialty services resulting from avoidable complications. Based on the evidence we have now, that will simultaneously result in lower overall costs, healthier patients, and happier doctors.
What's not to like? The problem is that these are all wonky arguments that most people don't understand. It's very easy for politicians to distort the issues and scream about bureaucrats and government takeovers and similar scare words. After 20 years of screaming and yelling about these issues, I despair of ever cutting through the fog and getting average folks to understand.