The Medical Home concept has been around for a couple of decades at this point, but more recently it has received acknowledgement as a means to improve health care quality. Medical homes have a tremendous emphasis on primary care and thus on eliminating high cost healthcare, surgery and treatments before they even start.
What is a Medical Home
According to the Wisconsin Academy of Family Physicians, the Patient-Centered Medical Home model is built on the premise that patients develop relationships with their family physician and receive coordianted care through a team approach where nurses and other members of the staff manage patient education and documetation, freeing him to concentrate on what he does best. In the US, studies show patients with a primary care physician had 33% lower costs of care and were 19% less likely to die – than patients who worked solely with specialists.
According to a report by Deloitte Consulting "two trends are helping to build momentum around the medical home model:
- a growing shortage of primary care clinicians due to adverse practice conditions; and
- the increasing prevalence ofchronic diseases among the U.S. population." "
Deloitte notes, the medical home model is promising because it has the potential to reduce overall costs in the U.S. health system. However, the concept is also problematic given the system’s current lack of incentives around chronic care coordination and preventive health programs, as well as the divergent interests of specialists and acute care practitioners.
What Next?
So, the evidence exists that medical homes reduce costs and improve quality of care for patients. How do we overcome the lack of incentives around chronic care management and preventive health? Who has a stake in this who has been largely absent from this debate?
Answer: Agents and Brokers
If agents and brokers could get behind these concepts and at the same time bring businesses to the table and demand better and more efficient purchase of health care a huge difference would be made. The solution has to come from the demand side, not the supply side. Agents and brokers, helping their clients make improved health care purchase decisions, can make that happen and demand better purchase options like a plan that includes a Patient Centered Medical Home.
Lean Processes
The present payment system is seriously flawed. Providers are rewarded for over utilization by being paid on a "piecework" formula. The more procedures physicians perform, the more they get paid. There is little consideration for quality of the product delivered or for the overall health outcomes. Probably the most glaring issue is the latter. In 2006 the U.S. ranked 31st in life expectancy and 36th in infant mortality when compared to other countries in the world. "If the U.S. had a payment system that rewarded health outcomes the delivery of care would radically shift to more emphasis on prevention and less on sickness care. There would be intense efforts to prevent hospitalizations as well as focus on educating patients about health risk and self-care", according to John Toussaint, CEO of the Center for Health Care Value.
What can Agents do to Help Transfrom the System?
Employers must have an overall plan to reduce their total health spend. This is where agents and advisors can make a tremendous impact. Employers would see real savings in health care premiums if they were to target efficient networks or health plans with doctors and hospitals focused on quality and efficient care. How do they do that? One resource is Lean.org which has organized dozens of health plans and networks around the U.S. that are focused on efficiency improvements in their systems that lead to great value and quality. Employers simply cannot rely on insurance companies to develop value for them.
Lean Processes Explained
From: Institute for Healthcare Improvement
"The core idea of lean involves determining the value of any given process by distinguishing valueadded steps from non-value-added steps, and eliminating waste (or muda in Japanese) so that ultimately every step adds value to the process. To maximize value and eliminate waste, leaders in health care, as in other organizations, must evaluate processes by accurately specifying the value desired by the user; identifying every step in the process (or “value stream,” in the language of lean) and eliminating non-value-added steps; and making value flow from beginning to end based on the pull — the expressed needs — of the customer/patient."
Agents and consultants who can successfully help their clients reduce health care expenditures, while increasing quality health outcomes, would undoubtedly be among the most successful in the industry with referrals, policy renewals, and increased commissions.
2011 will be a year of tremendous change in health insurance and not entirely because of the implementation of the Affordable Care Act. In some ways change will occur, I believe, because of what the Affordable Care Act failed to address, that of health care value. That's why I believe as we begin 2011, we are seeing so much conversation around ACO's, Medical Homes, Wellness, and Lean processes and why so many are starting to see real solutions exist to solve our runaway healthcare spending.
