Expert Sees Future for Medical Home, If Price Is Right

Primary care physicians, including family physicians, have the potential to offer their patients a high-value medical home, but doing so may require a change in the financing of health care first, according to Robert Graham, M.D., a professor in the department of family medicine at the University of Cincinnati College of Medicine and a former AAFP EVP.

“If you have an established relationship with a primary care provider or a primary care team and you maintain that over a period of time, your health outcomes will be better and your costs will be less. Now is there anything about those two (assertions) that you don’t like?” Graham asked an audience of health policy experts attending a June 1 dialogue on the future of primary care. The dialogue was part of a series of open forums for discussing policy issues that is being sponsored by the Agency for Healthcare Research and Quality.

The assertions are backed up by data on the value of primary care that were not available just 10 years ago, said Graham, a former deputy director for AHRQ.

The value of health care is becoming an increasingly important concept as large companies switch from a cost-insensitive system, in which employees are unaware of the cost of their medical care, to a consumer-directed model, in which workers bear a greater burden of the expense of their health care. That switch also may force a change in the way physicians market their services, according to Graham.

“Somebody who says that I am going to structure my practice around the concept of a medical home -- that is to say, it is going to be systematic, it is going to be primary care-based, and it is going to return value to the individuals who elect to participate in it -- then you have a very saleable package,” he said.

That observation appeared to hold true among audience members. Asked whether they would be willing to pay extra to belong to a medical home, three-quarters of those attending raised their hands.

However, the current system of financing remains an obstacle to creating such a medical home within primary care, Graham said.

“We have a reimbursement system right now which is historically based in the concept of ‘break it and pay to fix it.’ Primary care is -- if you do it right -- a business plan that is 180 degrees from that. It is difficult to do the right thing, in the wrong system,” he said.

Difficult, perhaps, but not impossible.

“People are … finding ways to make these principles work. But any one of them will tell you it would be so much easier and so much better if we had a different financing system,” said Graham. He suggested that a more workable model might include a mixture of capitation and fee-for-service.