A Sound Proposal, But Look at the Implications

Magazines sometimes use what we call breakouts or pull quotes — one or two sentences in large type — to give a page more visual interest and to highlight important points in the article. If we had decided to use breakouts in our cover story on the patient-centered medical home, I would have chosen some words from page 23 and some from page 29.

Let’s remember that the medical home promises to improve care and control costs by giving primary care physicians more responsibility to coordinate care, including preventive care.

On page 23, Jim Bridges, MD, an executive medical director at Blue Cross & Blue Shield of Michigan, gives us some words of warning that, as we look at plans for a massive national reform, are worth keeping in mind: “I wouldn’t think of the medical home primarily as a cost-saving measure, because it’s really principally about quality, and in the short term sometimes quality can cost more.” So here I’ve been thinking that the medical home is a no-brainer, and I find that there might be good reason for some people to be cautious.

And then there is this perceptive comment from MediMedia’s Sue Willette, senior VP and growth officer, on page 29: “You might end up seeing some of what we know today as disease management delivered in a similar fashion, but with the primary care physician at the center, directing all the activity.” I am reminded of last month’s cover story about how PBMs are also expanding into the area that until now has been the domain of DM companies.

So it surprises me a little that what I thought was a benign evolutionary step in care coordination and cost control could have some disruptive elements. And I haven’t even mentioned specialists’ incomes!

MANAGED CARE November 2009. ©MediMedia USA

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