UnitedHealth leading the way on the medical home?

February 11, 2009

Read it to believe it.

The traditionally physician-hostile health insurer is backing up its commitment to the patient-centered medical home with dollars. In a pilot project involving IBM workers in Arizona, they are listening to physicians, and helping small and solo practices meet the strenuous requirements that the medical home demands.

If all the goals are met, primary care doctors in the program could see a 30 percent increase in revenue.

The potential benefits of the medical home will not be immediately apparent, and both UnitedHealth and IBM seem to realize that, acknowledging that “we’re not naÃ¯ve enough to think this is a silver bullet.”

Let’s ask them again in a few years.

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Tagged as: media, patient, primary care

{ 19 comments }

1 The Happy Hospitalist February 11, 2009 at 8:21 am: The Medical Home Model Just Took A Dump In The Medicare Toilet
2 Anonymous February 11, 2009 at 9:08 am: You guys in primary care just don’t get it. Insurance companies are not your friends. Medical home means less pay for all physicians to them, otherwise they would not be interested. Don’t you remember the “gatekeeper” concept back in the late 80″s and early 90’s. All physicians got screwed.
3 Carla Kakutani MD February 11, 2009 at 9:50 am: I haven’t had a chance to fully see the details of these studied programs you link to, Happy Hospitalist, but it looks like these were mainly hospital based phone programs. The two programs that actually worked were much more linked to the primary physician office. The patient centered primary care medical home model is not the same as just hiring nurses with no connection to the patient to phone them frequently. There was a study a year or so ago that showed that McKesson-type commercial programs basically doing the same thing didn’t work either. Please compare apples with apples.
4 Anonymous February 11, 2009 at 12:30 pm: What’s significant about this program is that IBM, the payer, is announcing that they are dis-satisfied with the value they are receiving for what they are paying. They went back and forth with providers to try and get an arrangement that will work.

The insurance company, which presumably wants the business of a premier employer, is “helping” them.

Unlike a government program where the participants are “entitled” and always have their Congressman to complain to, an employer has a relationship with their plan participants where they can ask/reward/expect them to adjust their behavior. There is no assumption of equality in an employee-employer relationship. You can’t design a Federal program where people who don’t get their labs done pay more. A private program can be structured to reward or penalize those who aren’t compliant.

Change at the Federal level is difficult because everything is massive. A private employer deciding to institute changes to improve value might have a chance because they aren’t massive.

This model may work or it may not. What’s significant is that a corporation with stature has decided that maybe they can do something.
5 Anonymous February 11, 2009 at 2:38 pm: Group Health Cooperative in Seattle has been doing that for a while now.

Well……they do it in their Factoria clinic, in a seriously yuppified suburb of Seattle.

http://ghmedicalhome.com/

Here’s the article in the Seattle Post-Intelligencer (”intelligent as a post”). Catch it while the P-I is still in business.

http://seattlepi.nwsource.com/local/393129_medicalhome22.html

various other puff pieces linked as well, in the medical home blog.

http://ghmedicalhome.com/

Might be interesting to follow that blog. It reminds me of that old “diary of a drug rep”:

http://208.101.7.228/boards/showthread.php?p=2552587
6 Anonymous February 11, 2009 at 2:42 pm: Anonymous 9:08 AM – “….You guys in primary care just don’t get it……..Don’t you remember the “gatekeeper” concept back in the late 80″s and early 90’s……”

Well said, and right on the money. I AM in primary care, and I have absolutely zip, zero, nada, confidence in organized family practice. I think all the teacher’s pet types that curried favor with the teachers, beat the erasers, and snitched on the bad kids…..I think they all went into organized family practice. “Gatekeeper”, “medical home”, I swear FP’s “leaders” go straight to these steaming shitpiles every time.
7 Anonymous February 11, 2009 at 3:43 pm: I agree with anonymous 9:08 and 2:42.
The medical home concept is a gimmick.
Here’s a novel idea: just pay us better.

A family practitioner
8 Bad Medicine, Good Solutions February 11, 2009 at 5:30 pm: United healthcare is the same organization that is teamed up with Mary Mundinger, the Champion of the DNP movement. I highly doubt that this will be beneficial to patients or physicians alike. As the above poster aluded to regarding commercial insurance companies being more fluid for change than the government, it stands to reason a solo physician is even more capable. To quote an old phrase, “Physician, Heal thy self.” In other words don’t expect the government or insurance companies to fix a damn thing.
9 Anonymous February 12, 2009 at 9:59 am: ““What we buy is garbage,” said Dr. Paul Grundy, I.B.M.’s director of health care transformation, who has become a major proponent of the medical home concept.”

I second that. Until primary care comes up with a quality product, I wouldn’t pay them more money.
10 Anonymous February 12, 2009 at 10:41 am: Anonymous 9:59 AM:

Your logic is backwards.
You get what you pay for.
Because you are unwilling to pay more, you get an inferior product, ie quick visits by rushed doctors.
You shouldn’t say “make your product better and then I will pay you more.” Instead, you should be saying “I want my primary care product to be better and am therefore willing to pay more for it.” (Concierge medicine, anyone?)

The truth is, you’re bluffing. You’re not willing to pay more for anything. You probably think you already pay enough for it and still are not satisfied.

A family praxctitioner
11 Anonymous February 12, 2009 at 11:21 am: “You get what you pay for.”

If I hired a general contactor to replace my roof, would I find one that does shoddy work and then pay him more in the hopes that I will get a quality roof?

I already haven’t gotten what I paid for. And I am supposed to give you more money?

I am sure you are familiar with this:

http://www.em-news.com/pt/re/emmednews/fulltext.00132981-200812000-00003.htm;jsessionid=JJLT1Dnl1nJwc32LKZphYGnTb9HyQ2FzmfCkFFZDvCbhlnS1P1Z2!1204955331!181195628!8091!-1

“You’re not willing to pay more for anything.”

I am willing to pay more-for a quality product.
12 Anonymous February 12, 2009 at 1:16 pm: anonymous 11:21

For the sake of discussion, please define “a quality product.”

Healthcare is different than a roof.

A family practitioner
13 Anonymous February 12, 2009 at 2:04 pm: “To fund such a venture for groups that are singularly inept at performing anything of value to society is pure folly and a waste of precious health care dollars.”

“How could we as physicians ever allow a doctor to call himself primary care when he can’t manage simple chronic illness, cannot definitively treat acute illness or injury, often has no skills to save lives and no access to equipment if he had the skills, and does not even see patients at their own (the customers’) convenience?”

Jonathan Glauser, MD

What exactly does primary care offer?
14 Anonymous February 12, 2009 at 4:27 pm: Oh my.
Jonathan Glauser.
What do you offer?

A family practitioner
15 Anonymous February 12, 2009 at 5:28 pm: Wow, medical home and payment reform for primary care really is threatening to some people. I’m afraid the literature is on the side of primary care in this debate, no matter how you would like to belittle it. If you get your wish and primary care disappears, I’ll enjoy watching you try to deal with all the folks with mental health and personality disorders,the worried well, and the people who can’t pay your bills that currently never clog up your schedule because us useless primary care doctors are handling all that. Have fun!
16 Anonymous February 12, 2009 at 9:33 pm: “What do you offer?”

I offer you cash and you provide the service. If you don’t feel that I pay you enough, you should decline my business instead of providing me with substandard care.

Here are things I would be willing to pay a primary care physician. I would be willing to pay more in copayments, premiums, taxes, whatever.

1. Manage my chronic illnesses within the context of my life-not just offer me presciptions and treat me like a textbook

2. Treat acute illness or injury in a timely manner-especially those related to chronic illnesses.

3. Preventive care that goes beyond cholesterol and cancer screenings.

4. Treat me as a whole person, not just that symptom I came in for.

5. Treat me as a real person.
17 Anonymous February 12, 2009 at 9:40 pm: Ah, 11:21 AM. Drag up Glauser and his now-famous emotionally retarded adolescent rant.

Why don’t you check out this month’s issue of EM-News. Read his apology for that adolescent rant. He blamed his rant on a moment of anger and the terrible state of our medical care system. See, he’s the only one who cares.

He’s like the guy in Forrest Gump who smacked his girlfriend and went on to blame that lying SOB Lyndon Johnson for his behavior.

As it turns out, Glauser wrote something very similar in the same trade rag in 2001.

So, emotionally retarded, he insults whole specialties of physicians, sitting on the high horse like he’s the only one with skill and ethics. Then he blames others for his actions.

But, sincere or not (personally I doubt his sincerity), it is telling that you would quote such an emotionally retarded individual.

I doubt any primary care physician would shed a tear if you took your business elsewhere.
18 Anonymous February 12, 2009 at 10:27 pm: Anonymous 9:33 pm:

I feel that I do all 5 of the items listed in your comment.

If you are serious about willing to pay more, please comment again.

Then, I will be willing to give you my email address and if geographically feasable, you can come be a patient at my office. I will tell you my rates.

Quite frankly, I really doubt you are willing to pay more for primary care, but, hey, I’ll give it a shot.

A family practitioner
19 Anonymous February 12, 2009 at 11:50 pm: “Quite frankly, I really doubt you are willing to pay more for primary care, but, hey, I’ll give it a shot.”

Why would I want a doctor who doesn’t trust me?

“I doubt any primary care physician would shed a tear if you took your business elsewhere.”

I doubt it either.