Disruption in the Neighborhood? The PCs Build the Medical Home.

There’s a new house being built in the vacant lot across the street.  It’s the medical home, and it is going to be occupied by several primary care physician families (PCs).

From what’s been said, the PCs are nice folks and will make good neighbors.  They’re friendly, many are Episcopalian, they like white picket fences, and they have barbeques on Sunday afternoons. The neighborhood they’re coming from is not as well off nor as pristine — they’re said to be suffering from urban flight.

The current neighborhood residents are generally quite well off.  They include the Employers, the Hospitals, the Health Plans, the Specialists, and the Disease Management clan.

The long-timers in the neighborhood are aware that parts of the world are not so well off and suffer from spiraling health care costs, inconsistent quality, and frustrated patients who don’t get coordinated care — but they don’t rock the boat too much because the system has generally been good to them.

Here’s the scene: this afternoon the Employers sponsored a pot-luck dinner to welcome the PCs to the neighborhood.  It was a festive event. The party’s over and everyone has gone back to their own houses.

What do the neighbors say about the PCs when they get back to the comfort of their own homes? Let’s listen in on a few discussions.

The Employers

“All the Employers are excited about the PCs moving into the neighborhood.  We want them to move in to the neighborhood as quickly as possible and start raising a family with lots more little PCs. The PCs provide good value for our health care dollar.”

The Health Plans

“The Employers who pay our bills have told us that we must welcome the PCs to the neighborhood.  Is that really a good idea?”

“Publicly of course , we’re all in favor of the medical home coming to the neighborhood.  And, to be truthful, we can certainly see a lot of positives.  The PCs are at the nerve center of much of health care spending, and we’d sure like to have the PCs reduce unnecessary hospitalizations, duplicated tests, and generally improve coordination of care.  That would be great.”

“On the other hand, having the PCs build the medical home changes our fundamental business model.  We’ve always depended on closed business models and proprietary IT, and we’ve competed heavily with other health plans in other neighborhoods.  And now, just think, we’re supposed to COLLABORATE — to work together with other health plans and the PCs on things like common clinical protocols, interoperable information technology, and untested payment methods that are foreign to how we operate.  Not sure we can do this, but we gotta smile on the outside.”

“And what about those Employers! It’s pretty intimidating when some of the larger bullies of the Employer family push their weight around and TELL you to welcome the medical home — OR ELSE!  Or else they’ll take their business to another health plan. The nerve!  Harrumph!”

The Hospitals

“Decades ago, the PCs and the Hospitals used to be great friends .  We’d fight, but fundamentally we understood our mutual dependence — the PCs needed the Hospitals to take care of their patients, and the Hospitals needed the PCs to admit their patients to fill beds”.

“Times have changed. We have much less interaction with the PCs these days.  In fact, we’re not sure that we have much in common for the future. This could be the straw that breaks the camel’s back in the Hospitals ability to get along with the PCs.”

“We’re suspicious of this medical home thing.  The PCs are pretty up front in stating that the funding to build the medical home comes mostly from reducing hospitalizations and emergency room visits.  ‘Scuse me, but can someone ‘splain why we’d want to cooperate with the PCs in taking business away from us? Unfortunately, it’s just downright un-American to say out loud what’s really on our minds.”

The Specialists

“Well, of course, most of us voice support for the PCs. But then, the emergency room physicians and the surgeons aren’t quite so sure.”

“But we know the PCs are jealous of us. They see that we have incomes that are much higher than theirs.  We’ve heard it’s just the opposite in most other parts of the world…is that possible?”

“The medical home makes us think twice.  On one hand, we know that we’re blood relatives with the PCs in the Doctor lineage.  On the other hand, we wonder whether this medical home really is just the PCs just reaching into our back pocket and taking dollars from our wallets to put into theirs.”

The Disease Management (DM) Clan

“The DM clan is a squabbly bunch.  We come from many different perspectives — services, technology, pharma, etc. — it’s hard to believe we’re all in the same family."

“The DM clan suffered setbacks this year.  We were heirs apparent to the role of being coronated “care coordinators”, but last January Medicare seemed to conclude (rightly or not) that DM doesn’t work.  More and more health plans decided they needed to coordinate care by themselves rather than work with outside full-service vendors.”

“So now the PCs want to do care coordination. We know that we have to get along better with the PCs, but the reality is that the PC’s moving into the medical home is ‘problematic’ for us.”

“First, The PCs also are a diverse family. We’re used to selling our DM technologies and services to the Health Plans, who typically buy our stuff on behalf of tens of millions or millions of their members. The extended PCs and their cousins consist of  about 300,000 physicians, many of whom dwell in very small cubbies of 1 to 4 doctors.  How do we sell into such fragmented and unfamiliar channels?”

“Second, some of the the PCs have judged us harshly in the past — they don’t trust us.  They thought we were interfering with their patients and practicing cook-book medicine, when in fact we were only trying to get patients to take better care of themselves. Given these past misunderstandings, how likely is it that the PCs will buy medical home support capabilities from us?”

“Finally, supporting the PCs will be challenging for our business model. In the past we’ve focused more directly on patients themselves— supporting them with education, motivation and tools to help them manage their own care.  Just focus on supporting the PCs, they say.  Easy to say, not so easy to do.”

So what do we all think of the new neighbors?  Well, the PC thing to do is to support the PCs…keep smiling

PS   I’m a big supporter of the medical home. The status quo is not a viable alternative. Please take this post as a reality check into issues that should be discussed in the open, and not just behind closed curtains.