Aug 01

Building a Patient-Centered Model of Care

by Wayne Oliver, Vice President of Pharmacy Advocacy & Governmental Relations at RxAlly
Originally published in the Atlanta Journal Constitution on August 1, 2012

Over the past several years, the health care system has been attempting to define and create a “patient-centered model of care.”  Most health policy experts, much less health care professionals, can’t seem to agree on what constitutes a patient-centered model of care. I think that a patient-centered model is less about discussing the comprehensive services offered to patients and is more about putting the patient in the middle of the relationship. A true patient-centered model surrounds the patient and provides a true coordinated personalized system of care.

In examining U.S. health care delivery, rarely are the words “coordinated,” “personalized” and “system” used in the same sentence ― much less actually delivered to patients.

Primary care medical homes (PCMH) were first developed several years ago in an attempt to develop a patient-centered experience. Even those physicians currently practicing in the PCMH model indicate that there are issues associated with the PCMH concept, like the challenges of coordination of care, integration of the team approach to health care services, disparate electronic platforms and the lack of a sustainable reimbursement model.  All of these challenges make the broad adoption of this model difficult.

Concierge medicine, where physicians offer services to a limited the number of patients, closely aligns itself to a patient-centered model. Based on a monthly premium paid to a concierge physician, patients have direct access to that physician for same-day office visits, the ability to engage the physician during non-office hours and personalized treatment programs tailored specifically for each patient. However, concierge medicine is often limited to physician services and the exclusion of other parts of health care. Concierge medicine is too costly for patients and too limiting in terms of the number of eligible patients to become the norm in the health care delivery system.

The Affordable Care Act ― better known as ObamaCare ― makes an attempt to create a patient-centered model of care.  Six of the 2,700+ pages are dedicated to the development of accountable care organizations or ACOs, which provide the framework for the better coordination of care between hospitals and physicians. ACOs provide “bonus” payments to physicians and hospitals when patients have lower than expected medical bills. But what about other areas of health care like pharmacy, long term care, physical & rehab therapy and other outpatient services? These health care providers are not even mentioned in the ACO section of health reform law and are not referenced in the rules and regulations. Let’s face it, giving a patient a high blood pressure medication is a lot less expensive than treating the patient for a stroke.

Health information technology (health IT) will go a long way toward creating the technical infrastructure to help facilitate a patient-centered model of care. The primary care medical home concept is predicated on the physician using an electronic health record as part of their practices. States are moving at various speeds in creating health information exchanges where health care professionals share clinical information about patients.

However, there is a demonstrative need for practice re-engineering and the realignment among the medical professions to begin rethinking what a true patient-centered model of care looks like.

To legitimately embrace a patient-centered model of care, physicians, pharmacists, nurses, medical technologists and other health care providers and professionals need to work around the patient… rather than working in silos on the patient. Health care services are in fact coordinated and in a manner which is least disruptive for the patient. It is an entirely different view of health care from which we know today.

How long will it take for the health care system to move to a patient-centered model of care? That depends.

First, we need to develop a payment system which rewards and incentivizes  a patient-centered model of care. We currently base our health care payment system on the number of transactions which occur: the number of office visits, the number of lab values, the number of prescriptions dispensed, the number of x-rays or CT scans. We need a payment system where health care providers are paid based on patient outcomes and which encourages wellness and prevention.

Secondly, we need to align the new payment model with patient incentives. Patients must be engaged and viewed as partners in their own care. For example, health plans should create reduced or eliminated co-payments for patients who are compliant with physician orders, or who properly execute treatment plans. Examples of this would include patients with hypertension who take their prescription drugs as prescribed by their physicians, which results in lower blood pressure readings or overweight patients who follow a diet and exercise program and subsequently drops those extra pounds.

Last, we need to encourage health care providers to work together as an integrated health care team. A patient-centered model means that all providers are equally responsible for the care, treatment and management of the patient. Currently, in our disjointed system, there is no single provider who is ultimately responsible for the patient and therefore, there is no provider who is accountable. In a team approach, the hospital, the treating physician(s) and the patient’s pharmacists are all communicating, reviewing, providing and exchanging clinical information – all with the patient at the center of the equation.

Patients deserve a patient-centered model of care where health care professionals and health care facilities are all committed to same goal: Optimizing patient health outcomes.

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