What is Patient-Centered Health Care Reform?

Mar 13, 2013

Photographer: Patrick T. Fallon/Bloomberg.

As the Patient Protection and Affordable Care Act (PPACA) continues to be implemented, we see health insurance costs continuing to rise and businesses forced to make uneconomical decisions to survive under its rules. At this rate, we’ll soon have to reform health care reform.

But with what?

In a Wall Street Journal op-ed outlining his proposed budget, Rep. Paul Ryan (R-WI) suggested replacing the PPACA with “patient-centered reforms.”

What does this wonky lingo mean? The Institute of Medicine describes it as “providing care that is respectful of and responsive to individual patient preferences, needs, and values, and ensuring that patient values guide all clinical decisions.”

Our current system is more physician-centered, as James Rickert writes at the Health Affairs blog:

[P]roviders often believe that we know everything about our patients and their care, but we are simply unable to accurately assess our patients’ perceptions of their care–what is important to them, how well we are delivering care, what factors in our patient care improve outcomes.  We need to attempt to move from “what’s the matter” with our patients to “what matters” to our patients.

One model of patient-centered care is the patient-centered medical home (PCMH). The American Academy of Family Physicians describes it in a 2012 white paper:

Within a medical home, each patient has an ongoing relationship with a personal physician trained to provide first contact, complex diagnosis, and continuous, comprehensive care. The personal physician leads a team of professionals at the practice level who are collectively responsible for the ongoing care of patients—many of whom are living with one or more chronic conditions. This reorganization puts primary care at the center of the patient’s team and better enables doctors, nurse practitioners (NPs), physician assistants, nurses, and other health care professionals to work side by side in caring for patients.

Think of this as a team approach to health care delivery. The patient would have a primary care physician managing their case, scheduling and analyzing tests, making diagnosis, arranging treatment with nurses, nurse practitioners, and other professionals, and monitoring the patient’s outcomes. As the white paper explains, “Care is coordinated and/or integrated across all elements of the complex health care system (e.g., subspecialty care, hospitals, home health agencies, nursing homes) and the patient’s community (e.g., family, public, and private community-based services).”

This infographic from the American Academy of Family Physicians illustrates how PCMH works.

The Patient Centered Primary Care Collaborative studied 46 medical home initiatives and found that the PCMH model improves quality, enhances outcomes, and lowers costs. For example,

  • The Alaska Native Medical Center had 50% fewer urgent care and emergency room visits and a 53% reduction in hospital admissions.
  • Danville, PA’s Geisinger Health System had 25% fewer hospital admissions and 50% fewer hospital readmissions.
  • Vermont Medicaid’s efforts resulted in 31% fewer ER visits, 21% reduction in inpatient services, and 22% lower per member per month costs from 2008-10.

Fixing the health care system doesn’t have to mean mandates, taxes, and stacks of regulations. There’s a way beyond a Washington-knows-best approach to one that makes patients the focus. Innovative, patient-centered approaches like the PCMH are a way to advance real health care reform that expands access to coverage, improves quality, and lowers cost.

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