The board of directors of America's Health Insurance Plans said last week that it will advance a medical-home model that emphasizes comprehensive care tailored to individual needs, care coordination among providers, adoption of health information technology and outcome measures to improve quality and affordability of care. Medical homes have been attracting attention as a means to boost primary care.
"Greater collaboration between patients and clinicians can help meet the individual needs of patients while improving the quality of care being delivered," said Karen Ignagni, president and chief executive officer of AHIP, in a written statement.
The payment structure for the medical homewhich swaps episodic care for a sustained relationship between patient and physicianshould support high-quality care coordination, AHIP concluded. Payments should be aligned with efforts to improve quality and efficiency, said AHIP's board, which is made up of executives from the nation's top health insurers.
James King, president of the American Academy of Family Physicians, said that his organization is pleased with AHIP's principles. "It's physician-led and patient-centered," King said. "All those things are very positive."
Michael Barr, vice president of practice advocacy and improvement for the American College of Physicians, agreed. "We're very pleasantly surprised in how much it agrees with what we've been saying," Barr said. "The core elements are very consistent with ours."
Both physician groups, along with the American Academy of Pediatrics and American Osteopathic Association, released joint principles on the patient-centered medical home in February 2007, and AHIP's core principles seem to echo that document.
One difference, Barr said, is that the physician groups think some efforts can be made to develop a patient-centered medical home without widespread health IT adoption. This principle keeps in mind that many physician practices are quite small and perhaps don't have the resources to deploy electronic prescribing or electronic health records, he said.
AHIP, however, states in its document that success of the medical-home model requires appropriate technology tools such as secure e-mail and e-prescribing.
Both physicians and insurers agree that pilot testing is needed to determine what approaches are the most effective. And more pilot projects are coming online all the time. The AAFP is now analyzing data from its pilot of the patient-centered medical home in 36 primary-care practices, Medicare's medical-home demonstration project will launch next year, and the Memphis (Tenn.) Business Group on Health is leading a local pilot involving multiple insurers, King said.
Health-plan participation is crucial to the success of this model, Barr agreed. "I don't think we'd be where we are now in terms of demonstration projects if it weren't for employers and payers."
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