Reforming Primary Care In the Commonwealth: Putting the Patient First

Posted by:
JudyAnn Bigby, MD, Secretary of Health and Human Services

 

Last week, the Executive Office of Health and Human Services announced the invitation of 46 primary care practices to participate in the Patient-Centered Medical Home Initiative.  This is a tremendous milestone in a progression that is essential to making sure that every person in Massachusetts receives high-quality, patient-centered primary care.

While the term ‘Patient-Centered Medical Home’ may not be as familiar to residents of the Commonwealth as ‘primary care,’ medical homes are vital to improving patient care, achieving good outcomes and lowering costs, both in Massachusetts and nationally. The state’s Patient-Centered Medical Homes Initiative is one of the key ways we are reforming the health care system in Massachusetts to be more responsive to people’s needs. The Patient-Centered Medical Homes Initiative is one solution to eliminating fragmented, uncoordinated care that risks a patient’s health and adds to the cost of care; it is a way to mitigate the increasing prevalence of chronic illness and poor management of chronic disease; and offers a solution to make primary care more attractive as a medical specialty.  The project recognizes the need to make it possible for primary care doctors to provide access to their patients when they need to be seen, to have the time to answer their questions and concerns, and to review their medical records and coordinate their care with others. It also recognizes the value of having nurse educators or community health workers or pharmacists as members of the medical home team.

Let me tell you why this is so important.  About 25 years ago when I started practicing primary care I would see a patient fit everything I needed to say and do in a 15-minute appointment whether they were coming for a cold or for follow-up of diabetes.  Twenty-five years ago we did not have the tools to effectively manage diabetes.  We spent most of the time managing complications.  Today, the science of medicine has advanced to the point where doctors know how to actually monitor how well a diabetic’s sugars are controlled can prescribe and monitor medications to prevent diabetic kidney failure, can prescribe and monitor medications to prevent heart attacks and stroke, and know what to do to help prevent blindness.  Yet most primary care doctors are still seeing patients in 15- minute appointments.  In medical homes doctors will receive payments for effectively managing their patient’s diabetes and for having a team who will help to monitor patients and answer their questions.  By moving away from reimbursing primary care doctors for 15- minute appointments, doctors can spend more time with their patients,

This year’s historic passage by Congress of the Affordable Care Act (ACA) provides opportunities to implement innovative health care payment and service delivery systems. The Patient-Centered Medical Home model, also described under the name, Advancing Primary Care, is one model highlighted in ACA. Having already achieved near universal coverage in the Commonwealth, with a 98% coverage rate, we can now take a hard look at how we deliver care, and how to make the most of the resources we have dedicated to health care.

In order to significantly lower health care costs and improve the delivery of care, we need to invest in different models of care. The Patient-Centered Medical Homes Initiative is not an experiment, but rather a long-term commitment to a change that Massachusetts must implement. Learn more about patient-centered, and about our initiative to create patient-centered medical homes in the Commonwealth at http://www.mass.gov/hhs/medicalhome.

Comments

[Patrice Levesque, MSM, RD, LDN]

Dr. Bigby,
Why don't doctors refer more patients to registered, liscensed dietitians? After all, we are the nutrition professionals. That would free up physicians to attend to other questions about diabetic management;ie eye care, foot care etc.
I whole heartedly support this model; but I would ask where are the RD's who could go into the homes and help patients with a myriad of health concerns regarding foods and nutrition? This is what we are trained to do.