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The Medical Home Model Relies on Significant Assumptions

Richard L. Reece, MD

December 2009
Commentary

As Congress considers ways to reform the health care system, a question that needs to be answered is how to save primary care. A number of health care organizations believe the answer to this question lies in creating patient-centered medical homes (PCMHs).

Paul Grundy, MD, director of health care transformation at IBM, is an advocate of PCMHs, in which primary care physicians (PCPs) would be paid by Medicare and Medicaid to coordinate the care of patients with chronic diseases and to direct patients to specialists. Critics of PCMHs say they would reintroduce the managed care gatekeeper concept, which was tried and failed in the late 1980s and early 1990s. Grundy counters this argument by saying that IBM, an international corporation, pays much less for its employees’ health care and receives better results in those countries that have wide access to PCPs who use electronic health record (EHR) systems.

Since the early 1990s, much has changed, Grundy asserts. In particular, more advanced health information technology systems have been developed that allow physicians to communicate with patients and other providers and that afford access to a wide variety of patient data that help these physicians to be more efficient at the point of care.

Sound Reasoning
The American Academy of Pediatrics introduced the medical home concept in 1967, and lately this idea has been gaining momentum as one that could help control costs and improve care, particularly for those patients with chronic conditions. Care for patients with chronic illness, such as diabetes, asthma, and cardiovascular disease, is costly and sometimes highly inefficient. There are many reasons the cost of care for these patients is high. One is the shortage of PCPs, and another is the current specialty physician-driven health care system in the United States. These ....

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