Pawlson said early research shows real potential for savings from fewer condition-sensitive hospitalizations resulting from better care in the ambulatory setting. Its not taking away money from other physicians, he said.
AAFP Executive Vice President Douglas Henley agreed.
Clearly, theres enough money in the system already, he said, pointing to a North Carolina medical-home program that reportedly led to savings of more than $231 million to the states Medicaid program in fiscal 2005 and 2006.
While a Medicare medical-home demonstration project is taking an extraordinarily long time to get launched, according to the AAFPs Henley, seven major plans have already signed on with the Patient-Centered Primary Care Collaborative with many announcing their willingness to participation in demonstrations: Aetna, Blue Cross and Blue Shield Association, Cigna Corp., Humana, MVP Health Care, UnitedHealthcare and WellPoint.
Though impressive, it remains to be seen whether this will be enough. Don Liss, a regional medical director for Aetna and Aetnas representative on the Patient-Centered Primary Care Collaborative, said that for a medical practices transformation to a medical home to be successful, a majority of the plans contracting with that practice have to be on board.
You cant change your practice for just your Blue Cross patients or just your Aetna patients or just your Cigna patients, Liss said.
Dick Salmon, Cignas senior national medical director for network collaboration, echoed Liss sentiments. We really believe the best way to move this forward is with multipayer, multiemployer collaborations, he said.
TransforMED, a practice-redesign arm of the AAFP, was launched with $8 million from its parent organization. Much of the money is going to fund a 36-practice medical-home demonstration (18 medical-home practices and 18 controls) which is scheduled to close in May. The AAFP has committed another $4 million for two more years of TransforMED operations.
Perhaps to head off any potential turf battles that could bog down this latest attempt to reform healthcare, Barr stressed two points: that the medical-home physician coordinating the patients care should be seen as a facilitator and not a gatekeeper; and that any physician could assume the facilitators role. It could be a cardiologist or rheumatologist, for example, it doesnt necessarily have to be a primary-care doctor, he said.
Dan Heinemann, senior vice president of the Sanford Clinic, Sioux Falls, S.D., also made it clear that the primary-care doctors will not be telling the specialists how to practice.
Not that a primary-care doctor is going to give direction to the specialist, they are going to direct the patient to the right specialist and give the specialist the information that they need, Heinemann said.
Another announcement made last week was that, under the direction of the four participating medical societies, the NCQAs online Physician Practice Connection tool will be modified to serve as a medical-home assessment instrument. The final version is expected to be released for testing in January, and will include three levels of medical homeness, Henley said.
He added that it can be used for practices participating in the demonstration projects or for nonparticipants to use for self-assessment so they can see what they have to do to first qualify as a medical home, and then what they must do to move up the scale.
Henley said the AAFP will be making a major grass-roots push to get its members to use the NCQA assessment tool. We want to show our members that this is a concrete example of where you have to be, so start moving in that direction and get to level one as rapidly as you can, he said. Dont wait for the world to change before you start to change.