Sounds like a rehash of HMOs. There will be an incentive to ignore
any patient problem that might lead to expenses for the provider.
Going to a single-payer plan could save a lot by simplifying health
provider bureaucracies. Shorten the length of patents. Prohibit
drug advertising. Many small steps could be taken.
Reporting on an experiment involving 36 primary care practices, the creators of the National Demonstration Project have concluded that transformation is possible in “highly motivated” practices, even without major changes to payment structures.
But such changes are needed to bring this patient centered medical home model into the mainstream.
To illustrate let’s play a game from my childhood, Goofus and Gallant. (They still appear in the magazine Highlights for Children. Image from Wikipedia.)
We’re both 55 now. I’ll be Gallant because it’s my story.
Goofus and Gallant were both diagnosed with hypertension 10 years ago but I’ve done my part. I exercise. I take my medicine. I watch my weight. I don’t smoke, nor drink to excess. I get plenty of sleep. I’m doing great, and twice a year I make a brief visit so my doctor can tell me so (and refill my meds).
Goofus didn’t listen. He’s like Roger Sterling in Mad Men, although not thin and distinguished like the actor John Slattery. He drinks like a fish, smokes like a chimney, never exercises, ignores all his doctor’s advice. He’s a mess. He’s had several heart attacks, been in-and-out of hospital, and wears a pacemaker.
Guess which one of us makes the doctor’s bank account go ka-ching. That’s right, it’s Goofus.
The medical home concept turns this on its head. Doctors get paid when patients don’t see them. They are compensated for wellness. When sickness comes, they do become gatekeepers, but their aim now is to change behavior, to keep their patient out of the hospital.
Under the medical home model I’m a medical profit center, while my friend Goofus is a dead loss. Precisely the opposite of what happens today.
The trick is getting from here to there. In a highly motivated practice there is enough traffic that wellness can be practiced. Such practices can take on more cases, then can sell patient monitoring solutions (like we discussed yesterday), and the numbers will work.
But for most practices they don’t. The problem is that the savings from wellness don’t go to the sellers of health care, they go to the buyers.
And that’s where the medical home needs to go now. Start with businesses which self-insure, the kind Virgin Healthmiles is targeting. Then create a model for insurers, in which patients who stay well are guaranteed a host of valuable wellness services, while those with bad physical driving records get the care they need and no more.
Goofus should be paying for his sins against wellness, and Gallant should be benefiting.
