Talking in the mirror won't get it done

As the health care debate rages on, it is apparent that many of the stakeholders are talking into the mirror.  They are conferencing with others of like mind and "preaching to the choir" as it were. This is certainly true for the decision makers who are trying to reform health care without a meaningful understanding of how the system really works and what actually occurs in the all-important physician patient relationship. The same is true for those in the trenches of health care who interact with patients every day. They also spend a lot of time talking among themselves - talking in the mirror – but they are not doing an effective job educating policy makers and their patients on the real issues in the national debate.

The gold standard for a patient centered medical home (PCMH) is "a continuous relationship with a personal physician coordinating care for both wellness and illness". PCMH is not about a continuous relationship with a health insurance company or employer. It is "for wellness and illness" not saving money for payers.

There is no question our system is broken at multiple levels. Patients often don't receive the care they need when they need it. Patients are not adequately engaged and informed about the cost and quality of the care they receive. Providers often function in ineffective systems with misaligned incentives. Health insurance companies are often perceived as a barrier to care rather than a facilitator of care. Our government struggles with its role in promoting the health and wellbeing of ALL of its citizens. Even the concept of the patient centered medical home gets distorted to meet various stakeholder needs as is evidenced by the blurring of PCMH and chronic disease management projects. The list is long and growing as everyone continues to talk in the mirror and seek out those that agree with their way of thinking or vision for the future.

The concepts of the patient centered medical home need to be leveraged to create patient centered high performing practices in high performing systems. Those actually involved in this important work need to preach and teach from the roof tops. Stakeholders and decision makers need to hear from those that actually walk the walk every day.

There is a lot of discussion today around the challenges of access, quality outcomes, efficiency outcomes, technology, accountable care, team care, community resources and the primary care workforce. All of these things are very important. All of these things are addressed by the concepts of the patient centered medical home. There is also a lot of discussion around the ultimate goal of meeting all of the challenges. Far too often the goals described by many focus on cost savings. There is no question we need to "bend the curve" which is the latest catch phrase for reducing costs. We need to slow the rapidly escalating costs of health care in this country so that we can realign resource to provide everyone with the care they need when they need it. We need to redistribute the money we are now spending to prevent disease and promote health and well being. We need to "bend the curve" to make sure that every patient in this country has "a continuous relationship with a personal physician coordinating care for both wellness and illness".

We already spend enough money in this country to accomplish this. We just need to stop talking in the mirror, get outside of our comfort zone and get those not taking care of patients on a daily basis to understand the real issues and opportunities. Those individuals working hard to transform their practices and how they deliver care to patients ask...how can I possibly do one more thing?  While the days are already long, the time is short and it is the PCMH champions that are in a unique position to make a real difference.