En­gag­ing pa­tients in care

Modern Healthcare - - OPINION LETTERS - Mar­i­anne Di­et­rick-Gal­lagher Se­nior con­sult­ing man­ager IMA Con­sult­ing Chadds Ford, Pa.

Re­gard­ing “Mixed re­sults seen on Blues med­i­cal-home project” (ModernPhysi­cian.com, June 8), I ap­plaud the pa­tient-cen­tered med­i­cal home work re­ported by An­dis Robeznieks and Dr. Sam Romeo’s staunch sup­port in his let­ter (Aug. 11, p. 21) for in­volv­ing pa­tients as in­te­gral part­ners in their care. Strength­en­ing health­care in the U.S. re­quires sig­nif­i­cant change in pri­mary-care prac­tices and pay­ment strate­gies. A pa­tient­cen­tered med­i­cal home pro­vides an ef­fec­tive means of con­tribut­ing to this change. Also, the PCMH goals of im­prov­ing out­comes while re­duc­ing cost dic­tate that pa­tients be ac­tive, en­gaged par­tic­i­pants in their care, thereby be­com­ing agents for that change.

Pri­mary-care prac­tices pur­su­ing PCMH sta­tus face con­sid­er­able changes in the way they work, in­clud­ing ap­proaches used to track pre­ven­tive care and treat­ment, along with those de­signed to mon­i­tor test and lab­o­ra­tory re­sults. Suc­cess­ful prac­tices im­ple­ment care-man­age­ment strate­gies and part­ner­ships with community agen­cies. They in­te­grate spe­cial­ists and acute-care in­sti­tu­tions us­ing clearly de­fined com­mu­ni­ca­tion chan­nels (of­ten elec­tronic in na­ture).

In ad­di­tion to cap­i­tal ex­pen­di­tures for in­for­ma­tion sys­tem in­stal­la­tion or up­grades, PCMH prac­tices tend to hire ad­di­tional full­time equiv­a­lents to meet the in­creased work ef­fort. Pay­ers must rec­og­nize this ad­di­tional work and ex­pense through in­creased per-- mem­ber-per-month pay­ments and mone­tary in­cen­tives for qual­ity achieve­ments. As both Robeznieks and Romeo noted, pay­ers may re­al­ize ex­pense sav­ings. Lower ex­penses re­sult from a re­duc­tion in in­pa­tient ad­mis­sions and a de­crease in emer­gency depart­ment vis­its.

Fi­nally, PCMH pa­tients must as­sume an ac­tive role in their care. PCMH stan­dards sup­port ac­tu­al­iza­tion of pa­tient in­volve­ment through pa­tient ed­u­ca­tion, pa­tient self-man­age­ment strate­gies and in­creased ac­cess to providers (open, af­ter-hours and elec­tronic ac­cess).

Work­ing to­gether, physi­cians, pay­ers and pa­tients can im­prove health­care in the U.S.

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