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The health care system of today is based on an entitlement-oriented fee for services model. Providers feel entitled to be reimbursed for the services they provide. The more services they provide, the more reimbursement they receive. The payers–both government and insurance companies–have not yet provided sufficient incentive to providers to shift the focus to health instead of treatment. A new model is emerging rapidly that will cause a shift to an accountability-oriented fee for value model. The intention of the new model is to increase quality and patient safety and improve outcomes while reducing cost.
A major systemic change to the health care model is arising because of the shift from volume to value. The change is the emergence of the patient-centered medical home (PCMH). The home in PCMH is not a place; it is a concept. The concept is for the primary care physician to coordinate the care of a population of people and recommend the care that is needed to keep that population healthy. Dr. Paul Grundy at IBM describes the primary care physician’s role as the “systems integrator”.  Under the PCMH, the primary care physician will focus on health instead of treatments and will use a full range of procedures and providers to achieve improved health including alternative medicine, home health care, follow-up calls to ensure medication compliance, and follow-up appointments to monitor progress. IBM is encouraging the use of email communications between doctors and patients to supplement the standard waiting room interval before being able to ask the doctor a question. The focus on health is more likely to keep patients out of the hospital where costs are significantly higher. Dr. Grundy has been aggressively pushing on the PCMH concept for more than five years and for obvious reasons–IBM has hundreds of thousands of employees and pays the bill for a lot of health care.  A healthier workforce is good for employees and shareholders alike. If you want to get some further insight about the PCMH, I highly recommend listening to a 21 minute video of Dr. Grundy’s recent talk.