The latest entry by Dr. Rob puts forth the notion that various advocates for medical care change ( single payer advocates or let the market have at it) tend to talk about a system and there is no system. There are multiple independent or variably dependent entities typically working in ignorance or purposeful disregard of the other's actions and influences and do their various jobs in often what is a myopic, self contained sphere of activity that sometimes only incidentally benefits either the patient of the health care provider ( forgive me for the designation) and too often does little good for either.He gives us a revealing thumb nail sketch of many of the players ( primary care docs, ERs, specialist, medical insurers, etc) that hits many nails on the heads. Whatever you can say about health care in the this county you cannot say it is coordinated.
All of this seems so obvious that I continue to fail to see how the increasingly hyped ACP version of the "Medical Home" would work wherein somehow the primary care doc (an internist if you go along with the ACP-United Health Care version of this latest dressed up P4P) would somehow accept responsibility for the comprehensive care of the patient. As long as the patient has the freedom to see whomever for whatever ( e.g. a orthopedist for his swollen knee who then sends him off for a MRI and PT outside of the watchful,comprehensive caring eye of the homie) the medical home doc cannot control the situation and therefore cannot reap the benefits of controlling cost, in the absence of which United HealthGroup would not be a player to begin with. It is looking more and more like a HMO-oid situation with a touch of P4P thrown in , significant restrictions on what the patients- and the doc - can do, plus a dollop of electronic records and a giant heaping of guidelines which will be more toothy than guidelines and a lovely icing of "continuous quality improvement" verbiage to suck in the corporate employer clients.
It does seem to be getting some traction as discussed in this latest press release from ACP which brags about recent grants received from Pfizer and others to study and implement the medical home plan.
The UHF and Pfizer grants, in addition to a grant awarded to ACP by the Commonwealth Fund in late 2007, will help ACP continue the design and implementation of practice-based resources for internists and their office teams. ACP Executive Vice President and Chief Executive Officer John Tooker, FACP, said the grants are an indication of how the model of care could be here to stay. “The patient-centered medical home, in coordination with the other components of the health care delivery system, is the future of health care,” he said.