I feel like handing out cigars.
My article — “Disease Management and the Medical Home Model: Competing and Complimentary” — has been published in the latest issue of Disease Management and Health Outcomes, a peer reviewed journal.
I’ve arranged with the publisher to make copies available through my website. You can download a copy here.
Why is this an important topic? Here’s the big picture:
- Current chronic disease management demonstration/pilot projects in Medicare are showing little evidence of success.
- Physicians have woken up to threats and opportunities relating to chronic disease management and care coordination. The Medical Home model is a unified proposal by primary care physicians to define the next generation of primary care.
How will these trends interact? Your thoughts are welcomed, and please feel free to comment on the article.
Congratulations on bring up a topic that deserves far more attention: the convergence of DM and CCM. And double congrats for being the first to get the idea in a peer reviewed journal. My only question mark has to do with the scalability of CCM. Most primary care is given in smaller clinic settings. There are many reasons to believe that the uptake will be spotty. What can be done at the Health Plan or DM level to overcome this?
Thoughts?
Jaan,
I think you’re correct in characterizing the Medical Home as the beginning of a convergence of DM and the Chronic Care Model (CCM).
This convergence is already creating a NEW ECOSYSTEM of companies to support care provider reintegration into disease/care management.
The doctors cannot do this by themselves; technological infrastructure and support services will be needed. The main issues in my mind are: 1) will physicians take a leadership role or simply a participatory role, 2) will physicians develop a mindset toward treating support companies as vendors or partners, 3) what types of companies are best positioned to support/partner with physicians in implementing the Medical Home model?
You ask whether DM companies or health plans can help the docs. While this is certainly possible, docs generally do not have a high level of trust with DM companies and health plans.
Thus, I expect that a whole new range of players will step up to the plate to work with the doctors in implementing the Medical Home — home health agencies, start up tech and service companies, pharmacies, PBMs, HIT companies, you name it.
In considering the convergence of DM and CCM, and the ability for doctors to “compete” in some sense over providing care-coordination services, I wonder who will be the patient advocate. The individuals suffering from chronic diseases, who are in constant need of efficient and effective medical care, need better tools to guide them through the cluttered system of care that currently exists in this country. I think that it is incredibly important for the health care community to begin supporting and educating consumers. Unfortunately, there is not enough of this happening. It seems like developments in new care models occur due to efforts made by the big companies, rather than the individuals driving need for care.
Ideas?
I just learned from an article I stumbled upon that Tax Relief and Healthcare Act of 2006 includes a provision for Medicare Medical Home Demonstration project.
While Medicare Health Support generated a good list of projects, I have not heard of any specific Medical Home Demonstration project. Vince, do you know what kinds of projects are there and what are the currents status, in delivering outcomes? Or nothing has started yet?
Medicare’s home page for the Medical Home demo project is:
http://www.cms.hhs.gov/DemoProjectsEvalRpts/MD/itemdetail.asp?filterType=none&filterByDID=0&sortByDID=3&sortOrder=descending&itemID=CMS1199247&intNumPerPage=10
I remember reading that Medicare is hiring an outside firm to writ the RFP and that a decision would be made around Sept 2007. This suggests that an RFP will probably come out late 2007 or early 2008, and that the demo would begin late 2008.
If anyone has more accurate dates, pls. let us know.
Vince