Report from CEO Terry McGeeney

PCMH Movement Requires Real Transformation

Economist Joseph Antos was quoted in a cover story in the July 13 edition of USA Today as saying that the Patient-Centered Medical Home (PCMH) movement needs to be more than just rearranging the deck chairs on the Titanic or an excuse to spend more money. I could not agree with him more.

The unfortunate truth is that many who are interested in the survival of primary care and the future of the US health care system realize all too well that is what could occur. The Commonwealth Fund again confirmed recently that the US spends more money on health care than anyone and does not have better outcomes to show for it. The country already spends too much money but it is not spent wisely or equally. The health care System of the United States truly is synonymous with the sinking Titanic.

One of the central problems is that the health care system today is fragmented and uncoordinated and instead of rewarding quality or outcomes it rewards volume and procedures. The RBRVS system implemented in the 1980's, in retrospect, was one of the worst things that could have happened to the US health care system and its citizens who find themselves as patients. It was like the Titanic -- it looked great when it was built, but ultimately sank.

The PCMH movement has created a momentum and opportunity to actually solve real problems rather than "rearrange the deck chairs on the Titanic". The trouble is that many of the initiatives around Chronic Disease Management have the potential to be nothing more than rearranging the chairs-- the old Pay for Performance Programs given new names.

The Patient-Centered Medical Home needs to be about reinventing all of primary care not just how primary care manages chronic disease. It needs to be about more than changing parts of primary care often referred to as "levels". It needs to be about patients being the center of health care and the driver of care rather than the passive recipient. It needs to be about rewarding the redesign of primary care around PCMH, not just rewarding better chronic disease management. It needs to be about rewarding real improvements in outcomes. It needs to be about primary care being the core of the US health care system to provide, collaborate and coordinate all of the needs of the patient for not only illness but to promote wellness. Many of the projects and pilots getting attention today are basically chairs on the deck. We need to focus on the ship.

Because the ship of the US health care system is sinking. It has already hit the iceberg. Rearranging the deck chairs and claiming change will not save the sinking ship. Spending money on a system the Commonwealth Fund and others say is not working will not save the sinking ship. Those interested in the health of our nation need to insist that the Patient-Centered Medical Home movement be about real change that is substantive and all-encompassing.