By Richard Asinof
PROVIDENCE – A bevy of national experts came to Rhode Island on May 22 to discuss how best to grow patient-centered medical homes, at a “think tank” gathering hosted by the Warren Alpert Medical School of Brown University.
In the audience were many of Rhode Island’s top echelon of health care policy experts – R.I. Health Insurance Commissioner Christopher F. Koller, Lt. Gov. Elizabeth H. Roberts, Rhode Island Quality Institute President and CEO Laura Adams, and Dr. Michael Fine, director of the R.I. Department of Health.
The experts presented a strong challenge to the current way of doing business within the health care delivery system, detailing examples of successful patient-centered medical homes in Alaska and Vermont that had transformed the business of health care.
Dr. Douglas Eby, the vice president of Medical Service for South-Central Foundation, Alaska Native Medical Center, talked about the importance of ‘preparing the soil” in order to grow a successful model of health care delivery. Instead of organizing around the needs of the provider, with an emphasis on tests, diagnosis and treatment, Eby’s Alaska health care model changed the emphasis to a customer-owned model, defining health care as a longitudinal experience, with “messy human relationships in play all the time.”
The results achieved by Eby’s model of health care over the last decade included a 50 percent drop in urgent care and ER utilization, a 53 percent drop in hospital admissions, a 65 percent drop in specialist utilization as well as evidence-based generational change in reducing family violence.
The shift to delivering health in a community context, rather than “disease care,” involved changing the workflow patterns. It began with learning to listen “at least 10 different ways at all times,” an investment in mentoring for all clinicians and management, and a way to “re-humanize” the story, defining care for a defined population.
In turn, Eby lambasted the idea that following LEAN methods or Six Sigma standards will change the delivery of health care. He saw it instead as turning health care into an industry production process.
Dr. Craig Jones, director of the Vermont Blueprint for Health, detailed the environmental factors that are necessary to support the growth of patient-centered medical homes, describing Vermont’s experience of building a community-based network of teams to support an integrated health care system. As a result, Vermont has seen a drop of more than 27 percent in the projected cost avoidance across its total commercial insurer population in 2010.
Dr. Paul Grundy, global director of IBM’s Healthcare Transformation, began by praising Rhode Island’s leadership in developing patient-centered medical homes. The focus in Rhode Island, he continued, needs to be on reducing the health costs of employees.
In a conversation before the event, Dr. Frank Basile, an internist with University Medicine, an early adopter of patient-centered medical homes in Rhode Island, suggested that there was a need in Rhode Island to recognize that the patient-centered medical home “was a small business that generates jobs.”
Dr. Patricia Flanagan, a pediatrician, speaking before the event, said that she wanted to see pediatrics better integrated into the framework of patient-centered medical homes in Rhode Island. All of the recent investments, she continued, has gone to identify potential cost reductions in chronic care for adult populations, with little focus on children.