 Thought Leaders: IBM: Patient-CenteredMedical Home |
Martín Sepúlveda, M.D, IBM
Technology leader IBM and UnitedHealthcare recently announced plans for a collaboration with select primary care physician practices in Arizona to launch a pioneering health care initiative – the “Patient-Centered Medical Home” (PCMH) model. Aimed at strengthening the primary care patient/physician relationship to enhance communication and service across the health care delivery system, the PCMH model provides comprehensive, information-supported primary care for children, youths and adults.
Martín Sepúlveda, M.D., is IBM's vice president of Integrated Health Services, and board certified in internal medicine and occupational and environmental medicine. Dr. Sepúlveda has received honorary induction into the American Academy of Family Physicians for his leadership in primary care transformation, and recently talked with hub about how this program will enhance the health care experience for IBM employees – driving improved outcomes and reducing costs.Q: What circumstances initially led to IBM's involvement in the Patient-Centered Medical Home movement?
A: Three years ago, I visited with physician organizations in primary care to talk about comprehensive primary care and the need to recast our delivery system in the U.S. as the foundation for health care purchasing and delivery. Our dialogue led to a health care reform movement now known as the patient-centered primary care initiative, which has brought together all primary care providers and more recently other key stakeholders including employers, health plans, pharmacy chains, disease management firms, and advocacy groups.
The view at IBM was simple: Strong patient-physician relationships in comprehensive primary care environments are the cornerstone of high-performance health care systems worldwide, and we need to create that in our own country. Further, we have the ability as a nation to create that delivery system with point-of-care information that creates highly interactive patient-care provider engagements, practice-based learning and administrative efficiency.
Q: In 2007, IBM spent more than $21 million for Arizona employees and their dependents in health benefits costs. How do you expect the PCMH pilot will help reduce those costs?
A: First and foremost, we are collaborating with the physician community in Arizona and with UnitedHealthcare in a practice-transformation initiative. The magnitude of change that these primary care practices must undertake to provide whole-person, comprehensive primary care with the administrative services of a medical home is enormous. Quality and efficiency changes will be implemented to office work flows; clinical care processes; information management and use of clinical decision support, scheduling, and team building; integration of UnitedHealthcare back-office support services; and care coordination systems – just to highlight a few. We are not expecting to “save” money in this phase. No one makes money during the construction phase of an apartment building, nor does anyone recoup his or her investment collecting the rent in the first year or two. However, over time, the gain is realized from 100 percent occupancy – and so will the gain be realized in a comprehensive primary care system.
Immediately, however, we expect increased value for paid services. We expect better adherence to evidence-based care, and better coaching, counseling and care coordination. We expect higher levels of patient engagement in chronic care management than is possible from disease management firms. We expect practices to know and manage populations through use of registries; we expect fewer errors with e-prescribing, reductions in adverse drug events, and better decision making from patient interactions with their physicians regarding services and choice of higher quality specialists when needed. This is short-term, big-time value gain.
Q: What do consumers without true primary care physicians miss out on, in terms of the overall health care experience?
A: New Zealand, the UK, the Netherlands, Spain, Germany and Denmark have all shown us that without a whole person, patient-family-community-oriented primary care relationship, we die sooner, we carry higher burdens of chronic diseases, we receive fewer preventive services, we have more difficult experiences at the end of life, and we are more frustrated and dissatisfied with our providers and our health care system in the meantime. If that’s not dismal enough, our health care professionals are also equally frustrated and dissatisfied both with their work environment and their practices.
Simply put: The patient-provider relationship in a primary care environment provides a great chance to improve quality of life for individuals, and addresses so many of the challenges facing our health care system – from chronic disease to wellness and ultimately, the affordability of health care.
Q: Why is the Arizona market the right location for the PCMH pilot? Do you expect to move the program beyond Arizona?
A: The Arizona location provides a perfect blend of three factors: first, UnitedHealthcare has significant market penetration, so practices have sufficient UnitedHealthcare patients to consider participating with this single health plan; second, the state has a progressive base of primary care practices that are willing to take on the difficult challenge of transforming themselves to deliver comprehensive primary care; and third, IBM has a critical mass of IBM-covered employees and families, providing for meaningful participation for our organization. The pilot is designed in a way that provides scalability for both large and small primary care practices, so we are hopeful that the successful initiative will expand to additional markets.
Q: What is the “draw” for participating physician practices in this program?
A: It is an opportunity for practices to positively change the future of their profession. Because primary care as we know it is not viable, the patient-centered primary care model is the alternative sought in the market now. The transformation initiative encompasses the type of primary care these physicians were trained to provide but have been unable to deliver. These practices lack important support services in clinical care and technology that, through this pilot, UnitedHealthcare will provide and train them to use—at no cost to the practice. In addition, there will be reimbursement for achieving tiers of “medical home,” which also will facilitate the change process.
Q: How did IBM come to collaborate with UnitedHealthcare on this initiative?
A: IBM and UnitedHealthcare have a history of innovating and collaborating together. We share visions; and have the passion and commitment to extend boundaries, create new models, and challenge market practice.
Q: How do you see the future unfolding for the PCMH pilot and the model in general?
A: Reducing the reliance on fragmented specialty care with a strong foundation of comprehensive primary care is a national reform imperative. We are leading the way with this primary care transformation initiative, and others are engaging as well with “medical home” pilots throughout the country.
We know from transnational experiences that the model works. The key to scaling will be the necessary changes to infrastructure including information technology; delivering the point of care clinical decision support and actionable data to patients and providers; solving the practice environment/professional recognition and other barriers to attracting physicians in training to the field; aligning payment to create the right incentives and behaviors; and having the right expectations for which results will come in which phase of the transformation.
The challenges are great, but the gains will be undoubtedly greater.
