Cath Lab Digest

Las Vegas—Utilizing patient-centered medical homes and increasing the use of health information technology may help the healthcare industry battle growing healthcare costs while providing high-quality care. The benefits of medical homes and the role pharmacists can play in the treatment system were recently discussed in a session at the ASHP meeting.

According to David W. Bates, MD, the current medical system is broken and has “untenably” high costs and high levels of harm. Dr. Bates, who is the chief of the division of general internal medicine and primary care at Brigham and Women’s Hospital, also said that about 50 million people in the United States do not have health insurance. He said the current Congress will likely try to address the issue of healthcare reform by focusing on coverage for the uninsured and exploring ways to reduce costs.

Chronic diseases remain common in the United States and can be attributed to about three quarters of the country’s health expenditures. Dr. Bates said that 83% of the population over age 65 has a chronic condition, and that by 2015 it is estimated that 150 million people will have at least 1 chronic condition in the United States.

Primary care physicians can play a critical role in the healthcare system. This comprehensive and continuous method of care has been linked to improved health outcomes, lower costs, and a more equitable distribution of care.

Medical homes are one option to revitalize the primary care industry. Medical homes are physician-led teams that provide integrated and comprehensive care. This format uses clinical information systems to assist in patient care and includes routine patient feedback to physicians and a focus on dignity and respect. Medical homes also involve the patient in the decision-making process.

Across the country, medical home demonstration projects are being conducted to evaluate this treatment approach. Most of the demonstrations are funded by the Commonwealth Fund and have a fee-for-service payment structure. The Commonwealth Fund was established in 2005 with the goal of creating a path for the US healthcare system.

Dr. Bates outlined attributes necessary for organizing and delivering healthcare. The attributes include making sure that patient information is available to all providers through electronic record systems, ensuring that patient care is coordinated among multiple providers, and making sure that all members of the care team are accountable to one another and can review each other’s work. Patients also need to have access to care and information even after hours.

Medical home demonstrations are important for the future of healthcare because research indicates that they can improve the patient experience and help provide better quality and efficiency. Dr. Bates noted, however, that there are gaps in the evidence and that demonstrations need to be rigorously evaluated to determine their effectiveness.

The components of a medical home vary substantially from one practice to another, including payment methods. For instance, the Goroll Payment Model is structured so that practices receive a yearly, risk-adjusted payment for the comprehensive care of every patient in the practice. This payment covers the cost of expenses in the practice and salaries.

The medical home system can help physicians gain greater control over patient conditions like hypertension, cholesterol, and asthma. Dr. Bates noted, however, that there is a need for more care management, social services, psychiatric support, and information technology.