Comments on: The Medical Home: Advancing, But Still Many Questions

By: Robert Nouman

Robert Nouman — Wed, 09 Sep 2009 12:31:29 +0000

Unfortunately, unless there is a significant “segmentation” of the typical primary care panel, and a medical home payment only for those with existing, and importantly, IMPACTABLE, high cost conditions, there may never be a real business case for this model. To date, I have seen fees such as $5 per member per month as the additional payment for a medical home care coordiation. Under the BOTE model proposed, that would mean that a payer would realize a 30:1 return on their incremental cost! My conclusion is that we have a long way to go to define the “value proposition” of the medical home

By: Fergal Tully

Fergal Tully — Thu, 27 Aug 2009 07:43:06 +0000

Let’s assume what you are saying about saving $150 per patient per month is correct, this is should be a very achievable target. I don’t have true cost of accommodation in a hospital but safe to say that it runs into the hundreds of dollars per night. So in my mind it is an absolute must that we invest in the home care project in order to give better care to the elderly and to reduce costs. I know that the amount of home care is growing, but I question the real commitment by the health service to make it work on a larger scale.

By: Randy Williams

Randy Williams — Fri, 15 Feb 2008 04:09:07 +0000

This paper from our smart colleagues at Deloitte is indeed timely. The BOTE analysis of the cost avoidance required to make this a viable option is truly a “first generation” attempt, but it should open the eyes of regulators, legislators, and payers who believe that this approach will be a panacea for American Medicine. Unfortunately, unless there is a significant “segmentation” of the typical primary care panel, and a medical home payment only for those with existing, and importantly, IMPACTABLE, high cost conditions, there may never be a real business case for this model. To date, I have seen fees such as $5 per member per month as the additional payment for a medical home care coordiation. Under the BOTE model proposed, that would mean that a payer would realize a 30:1 return on their incremental cost! My conclusion is that we have a long way to go to define the “value proposition” of the medical home, and perhaps that needs to start with a business case of what incremental services at what incremental cost would be expected to deliver what incremental savings for which specific patient groups. Sounds like DM 101 all over again! Haven’t we learned that “too good to be true” usually is?