State Legislators Champion Patient-Centered Medical Home

State lawmakers embraced the patient-centered medical home as an effective means of reducing costs and improving health care quality during a June 20-22 round-table meeting of the National Conference of State Legislatures', or NCSL's, Health Chairs Project.

The meeting was attended by 32 state senators and representatives who chair health care committees in their respective legislatures. During the event, legislators and guest speakers focused on a variety of topics addressing health system transformation, including state and federal health care reform, Medicaid, the State Children's Health Insurance Program, and the expansion of health care access through public and private partnerships. Primary care and the patient-centered medical home emerged as underlying themes throughout the meeting, underscoring the need for both in the minds of the health chairs.

"I was encouraged to hear that others -- not just family physicians -- are embracing the medical home concept," said Steven Crawford, M.D., of Oklahoma City, chair of the department of family and preventative medicine at Oklahoma University Health Services Center and chair of AAFP's Commission on Governmental Advocacy. "The medical home was central to many of the discussions at the meeting," he said.

During a brief presentation before the Health Chairs Project and an extensive follow-up discussion, Crawford described the patient-centered medical home as a "partnership between a patient and a personal physician built around preventive and primary care." He stressed that the medical home is "organized around the needs and wishes of the patient rather than the doctors or the insurance companies," adding that the medical home is based on a team approach for providing and coordinating health care.

"It offers close-up support from a personal physician who helps the patient navigate the health care system," said Crawford.

Crawford, like other speakers, said the nation is in a "health care crisis," creating pressure for systematic reform that continues to grow because of increasing health care costs and the rising number of uninsured individuals.

"Many people like you are calling for system reform that recognizes the critical role a vibrant primary-care oriented system can have in improving quality while holding down costs," he said.

He also assailed the "flawed (physician) payment system," saying that it is "unsustainable." Under the medical home model, physicians would receive an additional $15 per member, per month fee to support care coordination and other services of the patient-centered medical home, according to Crawford.

"Acute episodic care would continue to be paid under a fee-for-service type of system," he added.

Crawford's presentation was followed by a question-and-answer period, during which he told meeting participants that "primary care is dying on the vine."

"We have underfunded primary care in this nation, and that is the reason people do not go into primary care," said Crawford.

He praised the growth of community health centers, but he noted that many of the centers lack physician staffing. The Bush administration has increased funding for the centers but has sought to eliminate funding for Title VII primary care training programs, the very programs that create more primary care physicians, lamented Crawford.

"Every year we have fought and fought and been able to restore (that funding) year in and year out," Crawford said. "But it continues to be anemically funded."