PERC - Integrated Care

Thursday, April 11, 2013 02:32 PM

Clinical integration: Patient-centered medical homes, medical neighborhoods and new systems of care

The federal health care reform debate crystallized one immutable fact: health care costs must be better controlled and providing more coordinated patient care is imperative. As the practice of medicine shifts in the near future, physicians must work to develop and sustain health delivery systems that break down silos of care and improve health care value using systems of care models like the patient-centered medical home (PCMH) and medical neighborhoods that connect specialists to primary care PCMHs. Key concepts to consider include care coordination, team-based care, patient-self management, shared decision-making and demonstrable, continuous improvement.

The federal law has a strong bias toward tighter integration of medical services, but tacitly acknowledges that most medical care is delivered in solo and small group settings. The reforms formally codify, and provide incentives for unaligned practices to consolidate as accountable care organizations (ACO), a revised adaptation of the now distant concept of “clinics without walls.” Formally defined, an ACO is a provider organization that takes on responsibility for meeting the health needs of a defined population, including the total cost of care and the quality and effectiveness of services. They can provide a structure for connecting delivery system reforms to payment reforms. CMS strongly supports the ACO concept.

Very real and practical challenges exist to building systems of care models that include patient-centered medical homes, medical neighborhoods and ACOs. The transformations that private physician practices face will require a significant investment of resources in order to evolve internal systems to participate in new delivery systems and payment models. Beyond the up front costs of implementing health information technology, independent physician practices will need to make the necessary investments in developing leadership, management and operational capabilities to successfully uplink to integrated systems of care. Colorado is fortunate to be the home of many innovative demonstration, pilot and grant projects that are assisting physicians with making these transitions including the CMS/Specialty Society Systems of Care/PCMH initiative.