We live in an age of immediacy, fueled by 24/7 news cycles and a robust social media environment. We find humor in watching a cat chase a laser pointer, but our pursuit of the new and shiny is no less present. One negative review can lead people to drop everything and change course. A restaurant can have a bad night, get a couple of negative reviews on Yelp, and find itself with empty tables as potential customers take their business elsewhere.
When it comes to health care, though, and decisions that affect the well-being of millions of Americans, immediacy shouldn't guide reforms or drive policy changes. It's prudent to assess research-grabbing headlines by taking a deep breath, maintaining a sense of perspective and not jumping to hasty conclusions.
This perspective is essential when reviewing a study that appeared in the Journal of the American Medical Association (JAMA) and has been garnering attention from the New York Times, Wall Street Journal and other outlets. The study, conducted by researchers at RAND, casts doubts as to whether patient-centered "medical homes" -- a care delivery structure designed to support teams of physicians in actively monitoring patients' health conditions and increasing care coordination -- are actually meeting their goals of improving patient health and generating health system cost savings.
RAND studied the Southeastern Pennsylvania Chronic Care Initiative, a multi-payer medical home pilot that allowed practices to earn bonus payments for achieving medical home accreditation recognition from the National Committee for Quality Assurance (NCQA).
The authors note that this isn't the only evidence out there. For example, a report released last year by the Patient Centered Primary Care Collaborative, assessing 46 different medical home initiatives throughout the country, found that significant progress is being made in reducing preventable emergency room visits and having patients spend less time in hospital beds. A recent evaluation of the community health teams/medical homes -- in Vermont, another multi-payer initiative found a 19 percent reduction in spending for children and 11 percent for adults with private health insurance.
As evidence continues to evolve about which medical homes are more and less successful in improving quality and reducing costs, it will be important to refine the definition of a medical home to maximize the benefits. The Vermont results in particular show that design matters. In addition to encouraging physician practices to attain NCQA medical home status, they also funded community health teams to work with providers to deliver effective prevention and care coordination services -- a hub and spoke model. In recognition of this and other best practices, NCQA has already updated their medical home accreditation requirements from those that were used as the basis for the RAND study.
It's also important to focus on the societal factors that necessitate a transformation in the way we practice medicine. There are three prevailing winds in health care that are converging to form a perfect storm that can't be ignored -- one, the aging of baby boomers is going to drive an escalation in health care utilization; two, the continuing rise in incidences of chronic disease like diabetes, heart disease and cancer pose a severe threat to our society on a number of health and economic levels; and, three, a serious shortage in the number of medical professionals available to treat these increasing demands.
The only answer to this situation is to find a better ways of keeping people healthy, warding off chronic illness and its symptoms and avoiding expensive, preventable emergency room usage and hospitalizations. That requires looking at patients holistically, which is precisely why the patient-centered medical home model makes sense. Rather than wait for patients to come through the door with urgent health problems, providers in the medical home are given tools that allow them to monitor and proactively engage with their chronically ill patients on a regular basis, so that they can balance the many needs of patients with multiple chronic conditions and prioritize prevention issues by encouraging patient self-management.
There's no question that more research needs to be done and it will take time to assess how the medical home concept should be improved to achieve optimal results. But that's why you don't overreact to a single less-than-positive report; you learn from it. Medical homes are on the right track here in addressing America's daunting health care challenges. The key is to continue improving by staying on course, learning and evolving.
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