Stakeholders' Forum Pushes Patient-Centered Medical Home to Next Level

The patient-centered medical home, or PCMH, continues to pick up key support on the state and national levels, becoming an integral part of many public and private health care plans. That was one of the messages delivered during the Patient-Centered Primary Care Collaborative, or PCPCC, stakeholders' meeting here on Oct. 17.

More than 40 states have incorporated the PCMH as part of their Medicaid or State Children's Health Insurance Programs. At the same time, the Republican and Democratic presidential nominees have incorporated primary care and the PCMH into their respective health care reform proposals, clearly demonstrating that support for the medical home transcends party lines.

Meanwhile, a new Harris Poll, conducted on behalf of the PCPCC and released during the stakeholders' meeting, shows that more than 75 percent of U.S. adults would increase their support for the next president's health care reform plan if it contained elements of the PCMH.

"It strikes me that we are going through a lot of options with the American health care system," said AAFP President Ted Epperly, M.D., of Boise, Idaho, who moderated a panel on the health care proposals of the two leading presidential contenders.

Epperly described the PCMH as the "right model at the right time for America." The PCMH is "all about patients, all about relationships, all about caring," Epperly added. "It is all about delivering care now. It is all about shared responsibility with our patients. We need to be responsible to our patients, not responsible for them."

The stakeholders' meeting reflected the growing interest and support generated by the PCMH. When the collaborative held its first meeting two years ago, 30 people showed up; on Oct. 17, more than 350 people representing every segment of the nation's health care system filled a hotel ballroom to capacity in downtown Washington to learn and discuss how public and private payers are implementing the medical home.

During the past two years, the model has moved from the conceptual stage to the implementation stage, a fact reflected by the meeting agenda and the recent release of a document (57-page PDF; About PDFs) that summarizes PCMH pilot and demonstration projects throughout the United States. The meeting itself looked at the medical home from the financing, consumer and public policy perspectives.

Roger Merrill, M.D., chief medical officer for Perdue Farms Inc., a leading food and agricultural company, was one of four speakers to address the financing of the PCMH. Merrill explained that Perdue operates on-site wellness centers for its 22,000 employees who work at 18 facilities in 12 states. The wellness centers serve as medical homes for the employees and their families, providing "longitudinal care that focuses on health improvement," Merrill said.

Perdue also owns and operates its own provider networks, making it possible for the company to design its own payment models and to thus promote the provision of primary care services. Primary care physicians are among the best paid providers in the networks, said Merrill.

"We want our primary care doctors to smile when one of our patients comes in," said Merrill. "We don't want them saying, 'Here is someone else trying to jerk me around.'"

Merrill described primary care as an appropriate tool for better health, adding that at Perdue, "we have deliberately spent more money on primary care as a (positive form of) malice aforethought."

"The result is our overall cost (for employee health care) is dramatically lower than it would be otherwise," Merrill said.

Sarah Thomas, M.S., director of health care for the AARP's Public Policy Institute, was one of several speakers who addressed the PCMH in terms of the consumer experience. She urged providers and payers to include family members and caregivers as part of the medical home.

"It is not just about patients when you think about patient-centeredness; there are caregivers and family members to think about, too," she said.

The AARP's Public Policy Institute has spent the past year developing a model, known as the Framework for Health Security, that seeks to revamp the health care system through the integration and coordination of health care services and a greater, more effective use of health information technology, Thomas said.

"The medical home is a great example of a model that would do that," she said.

The afternoon sessions of the stakeholders meeting addressed the PCMH from the perspective of health policy reform.

Katherine Hayes, J.D., vice president of health policy at Jennings Policy Strategies Inc. in Washington, said the PCMH would be "seriously looked at and seriously considered" in the next administration's health care reform plan no matter who becomes president.

The health care reform debate in the next Congress and administration will focus on several key issues, including the overall cost of health care, the growing cost to businesses and families, and how the cost of health care is affecting the nation's economy and thereby its global competitiveness, said Hayes, who has served as a health policy advisor for Democratic and Republican members of Congress during the past 20 years.

"I think (the PCMH) is in a very good position in terms of cost," said Hayes. "You have demonstrated long-term savings for high-cost populations, which is what Congress is very concerned about."

Patient-centered medical homes, she said, "have been shown to improve quality in the health care system in terms of coverage and increasing access to primary care and prevention services."