Reforming the healthcare system in the U.S. will be a daunting challenge. Irrespective of how sweeping some of the reforms being discussed may seem, change will come incrementally and take several years to achieve. Providing access to health insurance to all Americans, while simultaneously optimizing the health care delivery system and lowering the rate of healthcare inflation, may seem unachievable, however this is the vision that is being created.

This issue of FUSE will concentrate on the evolution of the delivery system and specifically the emergence of a concept known as “The Medical Home.”

The origin of this concept surfaced in an IOM (Institute of Medicine) report, on primary care in the early 1990’s. The report later impacted the American Academy of Family Practice and the term “Medical Home” started to be utilized extensively in the literature by early 2002.

A variety of medical associations have jointly defined the Medical Home as, “A model of care where each patient has an ongoing relationship with a personal physician who leads a team that takes collective responsibility for patient care. The physician-led care team is responsible for providing all the patient’s healthcare needs and, when needed, arranges for appropriate care with other qualified physicians.”

Several studies conducted and published over the past decade indicate the need for improved healthcare delivery systems. Most notably, the model for Effective Chronic Illness Care, developed at Health-Partners in Minnesota and at Group Health Cooperative of Puget Sound (Bodenheimer, Wagner and Grumbach, 2002). Essential components of the enhanced model include clinical information systems that provide decision support for practitioners and prepare proactive teams to offer self-management support to informed patients. This research shows that these systems can produce effective, evidenced-based care, particularly for people with chronic disease.

The Medical Home model is not a futuristic vision of medical practice. Beginning January 1, 2008, the NCQA (National Committee for Quality Assurance) published a detailed set of standards and guidelines known as PPC (Physician Practice Connections) – PCMH (Patient-Centered Medical Home). The new standards allow physician practices to be recognized as Medical Homes. The perception is that there will be significant economic advantages for practicing physicians (groups) who certify as “Medical Homes” in the new health care delivery system.

The concept of the Medical Home is certainly not lost on healthcare policy makers currently working in Washington. The PCMH received special attention in The Baucus Plan. Additionally, in 2006, Congress required CMS to establish a demonstration program to test the Medical Home Model in fee-for-service Medicare. Early results were so impressive that Congress recently provided additional funding for CMS to expand the program.

The NCQA standards are detailed, quite specific and certainly too lengthy to elaborate on in this FUSE. However, I would bring your attention to two central themes of the standards: Advanced Electronic Communication (AEC) and Care Coordination (CC). AEC and CC are inseparable core elements of the fully functioning PCMH. Clearly, the full adoption and integration of the EHR (Electronic Health Record) and the PHR (Personal Health Record) functioning in an interoperable environment is the ideal standard. While the current stimulus plan will certainly accelerate this effort, we are still at least a decade away from large-scale adoption on a national level. Having said that, the NCQA standards fully recognize the limitations in the current environment and, while making significant concessions, still require rigorous standards of information exchange and coordination particularly between patients and physicians.

Managing the care of patients between office visits is a core requirement for physician practice certification as a PCMH. Patient-Physician connectivity will drive the care management process and create patient experience data elements currently missing from today’s healthcare data sources (i.e. claims, pharmacy, etc. based). The addition and integration of patient experience information into the electronic health record will not only enhance the relationship between doctor and patient, but will finally provide a more comprehensive view of quality patient care.

These multi-channel information pipelines will empower patients and provide their personal physicians with the knowledge and ability to more effectively and efficiently manage their care. These continuous communications, ranging from prompts, alerts, and reminders to sophisticated, customized self-care management programs, will allow caregivers with specialized training in patient behavior modification and motivational interviewing to advance the science of patient self-care.

Pharmaceutical manufacturers would be well advised to begin to include these patient-physician closed-loop systems in the design of their brand’s marketing and promotions programs. The creation of linkages between pharmaceutical professional (physician) and consumer (patient) driven marketing programs will better position the industry to integrate value added, medication based programs and services into the PCMH.

I would strongly encourage pharma brands to deploy integrated (professional/consumer) solutions to gain the necessary experience that will be required of all health care entities.

Demonstrated capability with integrated patient-physician communications, particularly as they pertain to medication-centered programs will make the pharma industry a sought-after partner. Physician practices will increasingly value pharma partners who provide patient-centered support services and programs that keep the doctor in the information loop. Segregated marketing solutions compromise a brands ability to capitalize on the benefits associated with coordinated communications between doctors and patients.

I would encourage brand leaders to seek out these certified PCMH practices for affiliation.

A list of physician practices that have been certified at PCMH’s can be found on the NCQA site. There are currently 3 levels of physician practice certification based upon a point system assigned to 9 NCQA standards.

The U.S. health care system’s current operating model is not sustainable. Adopting a PCMH model, particularly in the area of chronic care, could substantially alleviate the economic burden and improve patient outcomes.

There are, of course, substantial challenges to overcome. The question for all health care entities is: Will you be part of the solution or part of the problem?

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