Support for the patient centered medical home in the House health reform bill

by Thomas C. Bent, MD

As the House of Representatives prepares to vote on its historic health care reform bill on Saturday, family physicians are heartened to see the support it gives to the emerging new model of care, the patient centered medical home.

The House bill is good news on many fronts. It would provide health insurance coverage for some 96 percent of Americans and would reduce the federal deficit by $30 billion. The Congressional Budget Office estimates this bill would lower health care costs in part by improving health care delivery and relying on the medical home model with its greater focus on primary and preventive care.

Debate about this bill has been exceedingly contentious. In fact, thousands of people are demonstrating in the streets of Washington, D.C. as I write this. Yet at a deeper level, health care reform isn’t a Democratic or Republican political issue – it’s a non-partisan moral issue. Researchers at Harvard reported recently that 45,000 people die in the U.S. every year because they lack health care coverage and so cannot afford appropriate care. Many more die each year from entirely preventable chronic illnesses.

Three out of every four health care dollars – $1.5 trillion of $2 trillion spent on health care year in the U.S. – go toward treating chronic illnesses, most of them preventable. An estimated 133 million Americans have at least one chronic disease, such as diabetes, heart disease, cancer, stroke, or lung disease. In Los Angeles, public health experts have documented that 80% of preventable disability and death in that county is associated with chronic disease.

Our current health care system is failing our patients by focusing more on treating acute conditions – like heart attacks – than on preventing the causes, such as obesity that leads to heart disease. As a result, patients suffer unnecessarily and health care costs are spiraling out of control. We need a better model, with more emphasis on prevention, backed up by the excellent care our subspecialist colleagues provide.

Patient centered medical home efforts in North Carolina, Pennsylvania, Colorado and elsewhere have delivered improved patient outcomes and multi-million-dollar cost savings in recent years. Key elements include identifying patients who need preventive and chronic disease care and ensuring they regularly receive such care; providing extended office hours and 24/7 access to primary care physicians to prevent unnecessary emergency room visits; using evidence-based medicine to provide clinically effective and cost-effective care; delivering care with a physician-led team of providers working to the full scope of their respective positions; and coordinating patients’ care throughout the health care system.

We know what needs to be done – we just need the political will to align payment and medical education systems accordingly. That’s in part what the House bill would do.

The California Academy of Family Physicians believes that ensuring Americans can afford to seek care that focuses on keeping them well, managing chronic illnesses, and coordinating their care throughout the entire health care system is not a government takeover – it’s a humanitarian response to the crises faced by the millions of uninsured and underserved in our nation.

Thomas C. Bent is President of the California Academy of Family Physicians.

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