Quoting a patient he interviewed following a care delivery pilot project, panelist Allan Korn, M.D., said the member posed a rhetorical question: “Why do you call it a patient-centered medical home when it takes place in the doctor’s office?” Korn, the chief medical officer of the Blue Cross and Blue Shield Association, said the patient wanted the “medical home” to be where he lived.
The medical home is one of several models of care delivery in play as the industry struggles to replace fee-for-service with outcomes-based pay. And the panelists, who also represented industry heavyweights American Medical Association and American Hospital Association, said those models would emerge regardless of who controls the presidency--or Congress. Yet Richard Umbdenstock, President and CEO of the AHA, underscored the uncertainty over reform. While the industry understands the urgency of new delivery models such as the medical home, it is uncertain how to evolve to outcomes-based pay while being dependent on fee-for-service, he noted.
No one had a clear answer for that issue, but Korn continually brought the conversation back to patients. He laid out a scenario in which the patients would orchestrate care from the home, with some robust I.T. tools at their disposal. Korn proceeded to describe a patient-controlled encounter. The patient would view a touch-screen record, with photos of his various caregivers on the screen. Through the set-up, the patient would initiate communication and request calls from providers. “If we begin to think in those terms, to support patients with chronic illness, our workforce will go a lot further,” Korn said.
While he acknowledged the need for new delivery models, AMA President Jeremy Lazarus, M.D., said that patients still want their care to be led by physicians. “We need to pay attention of the scope of practice,” he said.
Other panelists noted that consumers will need to adjust their own thinking around health care if they are to evaluate what care is needed. The consumer orientation to health insurance also will need to change for the new reform models to work, Umbdenstock said. Consumers don’t mind not filing a homeowner claim on their house insurance, he said. But if they file no claims against their health insurance, “they think they are leaving money on the table. They think of it as prepaid service and we need to change that mindset.”