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Medical Home PowerPoint and Latest Perspectives
Last week my esteemed colleague Dr. Jaan Sidorov and I conducted a webinar for WRG on Patient Centered Medical Home (PCMH) developments.
The process of updating a PowerPoint forces one to collect one’s thoughts, and I’m glad to share with you the PowerPoint slides along with a few highlights about the evolution of the PCMH. The highlights:
Efforts to coordinate development of the PCMH are occurring through the Patient Centered Primary Care Collaborative (slide 15).
There are many PCMH pilot projects underway (slide 16).
CMS has “announced” that the Medicare Medical Home Demonstration project will not begin until January 2010 (slide 17). Legislation authorizing this demo was passed in December 2006, so why the delay? Not clear. Read this August 6 AAFP News Now article for further perspectives.
There has been an outpouring of support for the PCMH (slide 24), so much so that Dr. S. and I are both somewhat stunned.
Is the PCMH competitive with disease management (slides 25–26)? A year ago I wrote a journal article pondering this question, and basically sat on the fence. Today I’m off the fence — YES, the PCMH is definitely competitive with DM companies. Why? It’s not difficult to imagine that physician and DM company processes could be integrated regardless of who’s in the “lead”. However, holding the lead (i.e., getting the contract from Medicare or a health plan) will have a lot of business value — being higher up in the food chain will create disproportionate economic gains. Thus, the PCMH and DM are definitely competing.
The latest Medicare bill passed by Congress in July (the one that Bush initially vetoed) contained a provision affecting the Medicare Medical Home Demo (slide 21). The Secretary of CMS is given authority to expand the demo if it improves quality OR reduces costs. This is a much easier hurdle than the one burdening the Medicare Health Support demo, where the demo projects had to hit multiple targets simultaneously — improving quality, reducing costs, AND improving patient satisfaction.
How fast should we step on the pedal in implementing the PCMH (slide 27)? There are basically two schools of thought: 1) Researchers favor “Ready, aim, fire” — get your ducks lined up in a row, do RCTs, go slow, take forever, or 2) Implementers favor “Ready, fire, aim” — do experiments, fail, learn, try again quickly. You can probably sense where I stand on the issue.
Finally, the devil-is-in-the-details re: the PCMH (slide 28). There are many unanswered questions…stay tuned.
If these tidbits piqued your interest, you can still buy an audio CD of the webinar .
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The power point on Medical Home is quite complete.
Maybe another section on how Disease managment companies can integrate and/or support the medical home is a next step.
I found the Power Point presentation to be a great overview of the current PCMH situation. I agree with the previous post about DM companies integrating into the PCMH model. In fact, I have been moderating a related blog (http://blog.healthintegrated.com) in which this topic and several others are addressed. I have also been tracking and addressing some of the other demonstration projects on the blog as well. Feel free to gain additional insight or comment.