If you took a snapshot of the current
health care system in this country, it
would not produce a pretty picture.
Physicians are under constant pressure to
see more and more patients in less and
less time.
Health care costs continue to rise faster
than the economy. Employers, government
and individuals feel increased financial
burdens and still health care in the United
States compares unfavorably to much of
the rest of the industrialized world.
The reason for the unnecessary and inappropriate health care services that people
receive in the United States is that there is
little or no coordination of patient care
among providers, says Michael Culyba,
M.D., vice president of medical affairs for
UPMC Health Plan.
“We also need to recognize that primary
care in this country is a failing entity,” says
Culyba. “We need to redefine and redesign
primary care. That is a basic concept of the
patient-centered medical home.”
Smart Business spoke with Culyba
about the patient-centered medical home
model and how it can improve the current
health care system.
What is a patient-centered medical home?
It is an update of the old concept — the
family doctor. It is also a way of approaching health care that differs greatly from the
current system. Essentially, the patient-centered medical home means physician-guided, patient-centered care. The partnership between the provider, the patients and
their families is what makes it work. From
this partnership comes a holistic, coordinated plan of care that uses evidence-based medicine to produce better outcomes and lower costs.
How does this differ from the current system?
It differs in many ways. Most significantly, it would change the basis of how care is
administered. At present, most care is
episodic, illness-oriented and complaint-triggered. With the patient-centered medical home, care will become a patient-centered, physician-guided, cost-efficient
model that encompasses both the art and the science of medicine. Prevention, wellness and health will be its focal points.
Physicians will become partners with
patients and insurers in coordinating and
facilitating care to help patients navigate
the health care system. Patients will have a
personal physician who works with a team
of health care professionals in a practice
that is organized according to the principles of the medical home. Patients will be
treated within a context of their personal
medical history and life circumstances,
rather than just focusing on a specific disease or conditions.
There is much research around the world
that demonstrates that where patient-physician relationships focus on primary
care, people live longer, populations are
healthier, there is higher patient satisfaction and costs are lower. The emphasis on
preventive care that results from a system
such as this can help to lower disease rates
and reduce hospital stays.
How does patient-centered medical care differ from traditional disease management?
Most disease management programs use
case managers who are provided by the member’s health plan. The primary relationship in that arrangement is between
the case manager and the member. In the
patient-centered medical home model,
care and the coordination of care is the
responsibility of the member’s personal
physician and the physician’s health care
team. The health plan provides information
designed to help the patient and physician
work together to set specific health care
objectives and choose the best way to
achieve those objectives. The member
becomes more engaged in his or her health
care, and the health care system will be
better able to serve the needs of individual
members.
What are the biggest factors driving the introduction of this new concept today?
The current system is not prepared to
meet the needs of an aging population,
either now or in the future. Primary care in
this country is a failing entity. Each year,
the number of primary care physicians
drops by 6 percent. We need to redefine
and redesign primary care with the patient-centered medical home. New ideas not
only add value, they introduce new perspectives from which we can examine
value and extend it. The world of health
care is one of constant movement and transition. But the main objective never
changes: the well-being of the patient.
How can this system benefit employer
groups that provide health care for their
employees?
If this concept is able to redefine the
concept of service excellence, it will be a
start toward making health care work better for all of us. That will mean more efficient care, healthier employees and lower
costs. This will work through a series of
partnerships. The health plan partners
with its members, with the employer
groups it works with and with its physician community.
MICHAEL CULYBA, M.D., is the vice president of medical affairs for UPMC Health Plan. Reach him at [email protected] or
(412) 454-5532.
