New White House Health Reform Director Ties Medical Home to System Overhaul Efforts

The Obama administration wants to move forward with a Medicare medical home initiative as part of an overall effort to reform the nation's health care system, according to Nancy-Ann DeParle, the new director of the White House Office of Health Reform.

"There are very robust demonstrations of (the medical home) going on right now in the private sector," DeParle said during an April 14 press briefing in Washington. "Some insurance companies are doing this already, and they have shown real promise. We hope to move forward with (the program) in Medicare."

The goal of the medical home is to create a less fragmented health care system by having a primary care physician or clinician coordinate a patient's health care, said DeParle. "(The model) is centered on patients to make sure they are getting the care they need when they need it, and to help them manage that and understand the importance of being compliant with their medications."

DeParle, a former commissioner of the Medicare Payment Advisory Commission, said, "There are legions of stories of people who are just going back and forth in the system. If you are a senior in fee-for-service Medicare, you have a lot of choices, but you could be referring yourself to (sub)specialists." These subspecialists, however, often don't have all of a patient's medical records, so they may not know all the treatments patients are receiving and whether they are prescribing the right medications, she added.

DeParle said the administration's health care reform plan seeks to accomplish the twin goals of reducing health care costs and expanding coverage -- two goals she described as intertwined.

"I think all of this is within our grasp," she said. "I think we can get everyone covered, and we can lower costs."

The administration's reform plan would build on the existing system of employer-sponsored health care plans, while strengthening the current fee-for-service payment system by changing incentives to reward the coordination of care.

"We want to move toward things that will bend the (cost) curve to create better incentives for physicians and hospitals to treat patients in a smarter way," she said.

For example, the administration wants to "incentivize physicians to use electronic medical records in a meaningful way for better treatment, better care, more conveniences and better administration in their offices," DeParle said. "That is building on the strength of the fee-for-service system and trying to make it better."

The administration also strongly supports prevention and wellness initiatives, as well as comparative effectiveness studies to improve quality and lower costs. The recently enacted American Recovery and Reinvestment Act provides $1 billion for prevention and wellness programs and $1.1 billion for comparative clinical effectiveness research, said DeParle.

She reiterated that President Obama is committed to the enactment of health care reform legislation this year. Obama submitted a 2010 fiscal year budget in February that includes a $634 billion reserve fund for health care reform. The House and Senate both passed budget resolutions with the reserve fund intact, a clear sign that Congress is serious about passing health care reform legislation this year, DeParle said. "Congress has put its money where its mouth is by saying, 'Yes, this is in the budget.'"

DeParle referred to the reserve fund as a down payment on health care reform, a place-holder to help the administration and Congress work out the details of a health care reform plan.