The patient-centered medical home isn’t ready-made

It’s a cold and rainy morning, and we’ve traveled to the middle of Central Pennsylvania to see a presentation at a conference about a patient-centered medical home product produced by one of the largest health care systems and insurers of the region.

There are clinicians and administrators from all over the eastern half of the U.S. (plus one from California), and also a large contingent visiting from the U.K., on a whirlwind tour to learn about innovations currently taking place in the U.S. health care system.

We are on a large, rambling campus, with hospitals, research buildings, conference centers, auditoriums, and we have been fed and watered, and now the conference begins.

The morning consists of three hour-long lectures, long PowerPoint presentations outlining the problems out there and their innovative solutions, with the ultimate goal of hoping that our organization and others here will buy into their way of doing things. Although we haven’t seen a sales pitch yet, we’re pretty sure it’s coming.

They’ve invested a lot of effort into this, and a lot of money, and we’ve put a lot of energy and effort into this as well, taking time out of our practice, renting a car, paying the enrollment fee, room and board, a long drive down the interstate.

The medical director of our practice and I are here, and we sit with our inch-thick, glossy colored binders, listening to the presenters, watching the slide show, taking notes in the margins of the slides in our packet.

Is the answer here? Is this the way? If only we did it this way, it would all work out just fine. The providers would be happy, our staff would be happy, our patients would be happy, our phones would be answered, bureaucratic trivia would be eliminated, and all of our patients would remain healthy, safe, and well-cared for in the outpatient world where we want to keep them.

We try to catch the pearls, think about the things that will work in our practice, tease out the best practices that we can implement in our system that is different from their system, that is different from every other system.

It would be nice if the clean, ready-made, complete package could be plugged into our practice, but that’s unlikely to happen.

At best, I think we will find a few great ideas, a few light bulbs will go off, and we will bring 10, 15, 20 ideas back to the practice, and see how we can adopt and adapt them, see how our recalcitrant providers can be made to change, how our noncompliant patients can be made to comply, how our staff who are stuck in their ways can begin to bend and evolve.

The answer may not be in the binder, but there is something to be said for a fresh perspective, an idea shared across the conference room, the lunch table, and the hallway standing around sharing ideas. We have all tried a lot of things, we’ve all had a lot of successes, we’ve all had a lot of failures.

And more of all of the above will come.

Fred N. Pelzman is an associate professor of medicine, New York Presbyterian Hospital and associate director, Weill Cornell Internal Medicine Associates, New York City, NY. He blogs at Building the Patient-Centered Medical Home

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  • doc99

    There are more things in heaven and earth than are dreamed of in your powerpoints.