AHIP “Adopts” Medical Home Principles: Huh?

On the surface, you might think that a press release issued by America’s Health Insurance Plans (AHIP) adopting principles for a patient centered medical home (PCMH) would advance the cause.

But, look further…

The principles endorsed by AHIP only vaguely resemble the Joint Principles of the PCMH endorsed by 4 major primary care physician groups . These groups represent over 300,000 physicians. (See below for a summary listings of AHIP and physicians’ principles supporting the PCMH).

Why?

• Why didn’t AHIP didn’t just endorse the physicians’ principles for the PCMH?
• If there’s disagreement, why didn’t AHIP say “we agree with the docs except for 1)…, 2)…, 3)…?
• Why leave it up to outside observers to have to line up and compare two different sets of principles of a PCMH and try to figure out similarities and differences?
• Where are the doctors in all this? What do the doctors think about AHIP developing their own set of principles for a concept that the docs themselves conceived and are laboring to deliver?

Here are few of my initial reactions to AHIP’s principles for the PCMH:

• AHIP’s prefatory comments make no acknowledgement of the motivations or financial pain that doctors are experiencing. I would have expected remarks like “We recognize that primary care is in deep trouble. We value primary care. We want to help primary care survive and thrive. We recognize the need to act quickly before the bottom falls out.” None of this.
• Many of the principles have a paternalistic, finger-wagging tone to them. Is this intentional?, e.g.,
  • Clinicians who practice in a medical home environment should commit to being accountable…
  • Physician practices that incorporate the PCMH model will require new capabilities and infrastructure…
  • The benefits of a medical home only will be realized if both clinical practice and consumer behavior evolves, therefore, educating consumers will be a critical element in this evolution

AHIPs’ endorsement of the PCMH could have been an opportunity to rebuild long-strained ties between the health plan and physician communities…instead it leaves me scratching my head and wondering “what were they thinking?”

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AHIP Board of Directors Statement on Core Principles Integral to the Development of the Patient Centered Medical Home (Summary); June, 2008

1) Care should emphasize providing comprehensive care to meet patient’s individual needs.

2) Care coordination, a core component of the medical home, should be tailored to engage all patients as partners in their care so they can maintain or improve their overall health status.

3) Health information technology, such as registries, decision support tools, non-traditional methods of communication (e-mail) and e-prescribing, should be used to help ensure care delivery based on the latest medical evidence, and to facilitate care coordination across a range of health care providers.

4) Clinicians who practice in a medical home environment should commit to being accountable for improving clinical outcomes and patient experience, appropriate utilization of health care services, and ensuring transparency of reliable clinician performance data.

5) Physician practices that incorporate the patient centered medical home model will require new capabilities and infrastructure, and objective assessment will be necessary to t=determine if a clinician’s practice meets the core criteria and has the capabilities and infrastructure to serve as a medical home.

6) The benefits of a medical home will only be realized if both clinical practice and consumer behavior evolves, therefore, educating consumers will be a critical element in this evolution.

7) Payment methods should encourage the development of both a clinical practice infrastructure and processes that can provide a more efficient, coordinated and patient-centered care experience.

8) Pilot testing of structural requirements, appropriate measurement, and reporting methods should be completed before the patient-centered medical home concept is broadly implemented to determine which approaches are most effective.

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American Academy of Family Physicians (AAFP), American Academy of Pediatrics (AAP), American College of Physicians (ACP), American Osteopathic Association (AOA) Joint Principles of the Patient-Centered Medical Home (Summary); February 2007

• Personal physician – each patient has an ongoing relationship with a personal physician trained to provide first contact, continuous and comprehensive care.
• Physician directed medical practice – the personal physician leads a team of individuals at the practice level who collectively take responsibility for the ongoing care of patients.
• Whole person orientation – the personal physician is responsible for providing for all the patient’s health care needs or taking responsibility for appropriately arranging care with other qualified professionals
• Care is coordinated and/or integrated across all elements of the complex health care system…and the patient’s community…Care is facilitated by registries, information technology, health information exchange and other means…
• Quality and safety are hallmarks of the medical home
• Enhanced access to care is available…
• Payment appropriately recognizes the added value provided to patients who have a patient-centered medical home.