Health Reform Trying To Get Its Act Together

Some physicists, not to mention authors of science fiction, posit that there are an infinite number of universes with infinite numbers of you and me making infinite decisions that are somewhat different from the ones we’ve made that have gotten us to this point in this particular universe. Some versions of me probably write longer sentences. Some versions of you will not continue reading. And some versions of the Affordable Care Act were rolled out smoothly.

That didn’t happen in this universe, however. Studies released last month that look at two bulwarks of the ACA illustrate just how much work needs to be done. The first asks: How effective are patient-centered medical homes (PCMHs)? Answer: Not very.

In a scathing editorial accompanying the study in the February 26 issue of the Journal of the American Medical Association, Thomas L. Schwenk, MD, notes that “there were no reductions in health care utilization of hospital, emergency departments, or ambulatory care services or total costs, and there was improvement in only 1 of 11 quality measures of chronic disease management, nephropathy monitoring in diabetes.” Advocates of PCMH of course have another view — in this same universe.

Then, the Centers for Disease Control and Prevention asks: How well are accountable care organizations (ACOs) performing in the Medicare pilot? Answer: Meh. They show varying degrees of success and failure.

Michael Millenson, a quality control consultant and a member of our Editorial Advisory Board, supports reform. “The PCMH is not important,” says Millenson ( “ACOs are a lot more important…. The risk was not very great and the reward was not very great. That’s why you have results that are extreme in neither one direction nor the other. ACOs are going to be a change that’s gradual because we don’t want to destabilize the health care system.”