IBM to announce results of Medical Home project

On Tuesday I was invited onto a blogger conference call hosted by IBM to discuss the Medical Home concept. I was immensely happy that IBM had the vision to invite a plain old ordinary patient to be on the call. Good for them!

As longtime readers know, I've written about the medical home concept several times. It's about the fact that so many people lack a plain old ordinary doctor's office where they KNOW you – a medical "home," as it were. (Or, as they say on Cheers, "Where everybody knows your name.")

Everyone else on the call was "in the business," and as it happens, the slides were far more "in the business-y" than I would have preferred. (They're posted below.) To get a concept like this into the skulls of the Very Smart Important People in government, it seems they have to talk in abstractions and Big Principles.

Suggestion: How about also including some street reality common sense facts? Like, people who have a medical home are half as likely to have a heart attack! That statistic was mentioned (in passing!) by IBM's Dr. Paul Grundy (who's become something of a buddy of mine) at the start of the call, but wasn't considered relevant enough to put in the slides!

See, IBM employs a LOT of people so they have a LOT of data about what works. 6-8% of their insured employees are in a Medical Home plan, and that's the result IBM has seen.

Wouldn't you like to be in a plan with that kind of results? Doesn't cost anymore, either. So what the heck is everyone else thinking, and what are they waiting for?

Hey IBM ... Since I'm officially a patient advisor to PCPCC, here's some advice :-)

• Let's also start some grass-roots demand for the medical home concept. (I'll start, by telling people here.)
  
  
• Somebody remember the 7/30 rule of slides: no more than 7 lines of 30 characters. More than that doesn't get read. :-)
  

Thanks for inviting a patient – I want to help this cause win.

Here are the slides:

IBM Briefing: Patient-Centered Medical Home - What, Why and How?

View more presentations from Ibm (ibv) Institute for business value .

"Medical home": where everybody knows your name

Originally titled "Dr. Ted on 'patient-centered medical home'"

Four weeks ago I posted about a wonderful development: "Patient Centered Medical Home" makes it into NEJM. Today Dr. Ted Eytan of www.TedEytan.com and newly of Kaiser-Permanente, left a comment:

Do you think the description in this article, and this one (on "the medical neighborhood") has enough information about involving patients? How would you advise this body to include them?

Rather than having that discussion get buried, I want to bring it up front.

The short answer is that those articles hardly say bupkus about patients themselves, but that's not what "patient-centered medical home" (PCMH) is about. It's about raising awareness that 40% of Americans don't HAVE a medical home.

When I first learned that last spring, from PCPCC's Paul Grundy (through my fabulous friend Leslie Harkins, who heard him talk), it stunned me. Heck, when I grew up, everyone had a family doctor who knew them. They don't anymore??, I thought.

No wonder, I thought, that PCPCC's data (from Dartmouth) showed such a strong correlation around the world between primary care and lower costs and good outcomes.

But for whatever reason, America's become increasingly focused on specialists, not primary care. And as that's happened, our costs have gone up and outcomes have declined. It's as if the whole system had started out with reliable, cost-effective Toyotas and gone backwards to costly rattletraps.

So I was really happy to see "PCMH" get its first bigtime publicity in a journal the establishment reads!

More about what's in those columns:

Early reports from focus groups suggest that the term "medical home" makes many consumers think of nursing homes, with all the unfortunate connotations.

Maybe they need a marketing consultant. 8^) Here's how I handle that when talking to people:

• "Home. Y'know, home? Like, the place where you always go?"
• "Like the Cheers song: 'Where everybody knows your name'."
• "Robert Frost: 'Home is where, when you have to go there, they have to take you in.'"

Well, okay, we're not yet to the third one - unless you're in the VA healthcare system, or some other countries. But if you've been reading what I'm posting about Best Care Anywhere, that fact may sound peculiarly interesting.

The first article does contain a mention of patients, which I hadn't noticed at first reading, regarding legislation to participate in a Federal demonstration program for PCMH:

These requirements stipulate that medical homes must have "an integrated, coherent, cross-discipline plan for ongoing medical care developed in partnership with patients and including all other physicians furnishing care to the patient involved and other appropriate medical personnel or agencies (such as home health agencies)." [Emphasis added]

Well that's a smart idea!

--- Hey, all you other patients - I know you're interested because you read my blog. :) Would YOU like to be involved in creation of this new system? Same for you healthcare workers - you know better than most people what we could create. Click the Comments link below. (Or if you're reading in email, come online and participate.)

"Patient Centered Medical Home" makes it into NEJM

In May I posted some slides from PCPCC, the Patient Centered Primary Care Collaborative, which has been working for years to promote the value of having a "medical home," a place where doctors and staff know you. We grew up with a family doctor, but PCPCC says 40% of Americans no longer have a medical home; increasingly we're handled just by specialists, and so many of us only get care by going to emergency rooms.

The "medical home" is not a concept that's widely acknowledged in America as something we should strive for. Even though most of the industrialized nations in the world have it, and even though their costs are better, and even though their health is better, we don't have it as a common concept in our healthcare conversations.

I'm very, very pleased to say that today's New England Journal of Medicine has an important column about this concept.

How ironic that it's described as a "new model of care delivery." Look at the slides in that PCPCC post, with all the data they have from every other modern country in the world - this is a new idea?

Perhaps it's American arrogance, thinking "Well, if we didn't think of it, it's new." (In business, that thinking is a good way to go out of business, as the American auto industry has been doing for decades.) I don't know. I'm just heartened to see a major journal like NEJM finally recognizing this information.

Patient-Centered Primary Care

I've recently been learning about a movement that started forty years ago: the "medical home." This is the idea that each of us should have a place we call home, medically. At first it was about keeping all your records in one place, but now it alludes to the reality that 40% of Americans don't even have a doctor's office they can call "home."

And the movement asserts that there are real, verifiable, measurable consequences of lacking that continuous care from a primary doctor who knows you.

I learned about this via the Patient-Centered Primary Care Collaborative (PCPCC), an employer-based coalition founded by IBM. Think about it: since employers pay the lion's share of health insurance, they have a strong interest in improving the cost-effectiveness of the health care they buy.

IBM also happens to employ people around the world - so they have tons of data about which systems work better and cost less. Guess what: there's clear evidence that where people have better primary care, their total healthcare bill is lower and their outcomes are better.

Yes, what works is to have a good old-fashioned family doctor, who actually knows who you are!

Here are some slides that have been loaned to me by Paul Grundy MD of IBM, chair of PCPCC:

| View | Upload your own

Disclaimer: I haven't personally done the research to verify the graphs shown in the slides. Anyone who has information to support or discredit these slides, please comment here.

No flaming, though! This isn't that kind of blog. Just information, please.

Recent posts on other blogs

Since my return 3/2 from the e-patient retreat in Texas I've been running around the health blogosphere, trying to get a grip on all the conversations that can make a difference in creating a new world for all of us. (Remember, your time is coming. Listen. Act.)

Dr. Ted Eytan is my new hero in the medical blogosphere: "e-Health. Patient Empowerment. Washington DC." Reading him is efficient - five good topics in today's brief post.

Benefits of electronic prescription ordering on Paul Levy's blog. (See the comments too. I've found that often the comments are as important as the post itself.)

Kevin, M.D. is a highly rated blog by an outspoken pediatrician who, I just figured out, is right here in Nashua N.H. You wanna hear someone saying how it all looks from the inside? Sign up to this one. Lo, look who was in the Wall Street Journal last week, as a result of being on the op-ed page of USA Today. He talks (frequently) about the shortage of primary care as a root cause of our healthcare problems. Good to see him getting some ink.

The primary doctor issue is the focus of PCPCC - The Patient Centered Primary Care collaborative. Here's a Healthcare Information Network post about PCPCC - it's cuckoo that PCPCC.net doesn't also have a blog! (Or if they do, it's not highlighted on their site).

Earlier this month good friend Leslie Harkins met with PCPCC's Dr. Paul Grundy at the Chicago confab of the American College of Healthcare Executives. His slides are hot stuff regarding the worldwide correlation between number of primary docs and overall better health. I'll be posting those slides here shortly. (Hint: more primaries = better health AND lower costs. No surprise that the US ranks in the pits on both scores.)

As Dr. Grundy said in a comment on that WSJ article: "Demand of ourselves and our Healthcare benefit companies: Comprehensive, continuous, patient centered, personal and holistic primary care which is based on strong relationships between patients and their physician — this is foundational to good health."