Patient-centered care: An idea whose time has come

In June 2010 FierceHealthCare reported: "The first national medical home demonstration has come to a close, and the 36 practices who put two years into transforming toward the model deliver somewhat discouraging news. Despite their intense efforts to implement same-day appointments, optimized office design, electronic prescribing, electronic health records, practice websites and more, the participating family practices registered modest improvements in quality-of-care measures but backslid in terms of how patients rated them, according to a set of eight articles in a special supplement of the Annals of Family Medicine."

Other studies are reporting more positive results.

Regardless the concept of "patient-centeredness" is absolutely moving us in the right direction but many of the tactics are flawed.

A few examples:

1.) Funding - Many of the PCMH pilots are using traditional Fee-For-Service plus Care Management Fees plus Pay-for-Performance "bonuses". These funding strategies have been tried before and have not led to significant improvements in patient / family / community health. The driver of care remains productivity (increase number of patient visits and ancillary testing). [See book "Overtreated" by Shannon Brownlee.]

2.) Integration? - Many of the PCMH pilots are defining integration as a care team of Physician plus an extender plus a nurse/medical assistant plus perhaps a liaison. True Integration integrates physical, mental, emotional, spiritual aspects of healing and addresses barriers such as environmental, financial, nutritional, etc. The extender model has historically been leveraged to decrease medical practice overhead while providing access. It is not true integration but a means to a financial end (with the upside of improved access).

3.) Care Teams/Model - We have seen first hand that patients ideally want a "personal physician" not a doctor plus extender; Someone they know, trust, respect and someone who knows them. Someone who has the time to understand the root cause of an illness and will co-create a patient-specific treatment plan with the patient addressing the barriers to the individual's health goals. Someone who can integrate an ideal team of healers specific to the needs of the patient, i.e., perhaps a physician trained in cutting-edge chronic disease management plus a psychiatrist to address with the patient mental health aspects of a disease and perhaps a nutritionist who is trained to work with the specific needs of the patient. A team of healers integrating and customizing their approaches to best meet the needs of a specific patient. With this type of model patients are engaged, feel respected and heard, and are more compliant.

4.) Broken paradigm - The health care system remains broken. Productivity remains the driver behind financial stability of health care organizations. Physician specialties remain siloed. The Institute of Medicine has stated the approximately half of medicine lacks scientific validity. The current PCMH pilots are being built in this broken system.

So again, wonderful concept that may provide some improvements in some areas and no doubt great learnings. But also great opportunities for improvement that can bring the system even closer to the ideal.