Engaging patients in care
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.