There's No Place Like Medical Homes

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The world changed on January 23, 2012, according to Paul Grundy, MD, MPH, president of the patient-centered primary care collaborative at the University of Utah. That was the date that WellPoint, which represents 39 payor markets nationwide, announced its care delivery redesign aimed at moving more and more health care to the ambulatory space. In his look at the “HIT-Powered Patient-Centered Medical Home,” Grundy provided valuable insight into the care delivery changes coming soon to a market near you.
 
The transition toward patient-centered primary care is also underway among the Blue Cross and Anthem payor plans. The benefit redesign is tied to four elements: measurable behavior changes and outcomes; expanded access through innovation; alignment of care management with the delivery system; and exchange of meaningful patient information.
 
What this means, Grundy said, is that hospitals are in the crosshairs, whether they know it or not. “How many beds do you need in a world where IT is fundamentally changing the way health care is delivered?” he noted, observing that one pilot medical home project in California managed to reduce hospitalizations by 24% and hospital stays by 38%. “And all these outcomes have happened in an ambulatory environment at a lower total cost,” Grundy said. “The future is happening now, and yet we build for the past.”
 
Further, your primary care referrers already know that the revolution is underway. As Grundy observed, it’s already the standard of care across all federal agencies, and a 2011 MGMA report found that 70% of responding primary care physicians were either on their way to this model or anticipated beginning the transition soon.

His comments were underscored in another presentation I attended, on the DoD and VA effort to create an integrated EHR. Dr. Karen Guice, principal deputy assistant to the Secretary of Defense for health affairs, noted that the MHS' effort toward greater patient centricity has come largely out of its patient-centered medical home group. Evidently there's no place like medical homes for driving the care continuum of the future.

What does all this mean for radiology? I brought Malcolm Gladwell’s excellent book The Tipping Point to read on the plane, in which Gladwell observes that any trend—in fashion, in technology, in lifestyle—“tips” when more influential users have succumbed to it than have not. Radiology has traditionally seen the majority of its referrals come from the hospital space, but as markets tip away from hospitals and toward ambulatory care, how can radiology practices adapt? What do you see as the potential role of imaging in emerging care delivery models?