21st National Conference – Reports from Thursday Breakout Sessions – April 15, 2010 13 years ago Bill Burnett 5 minutes Last Updated on April 16, 2022 by Lee Burnett, DO, FAAFPThe 21st National Conference on Primary Health Care Access met in six breakout sessions on Monday, April 12, 2010. The following question was posed to each of six teams:The concept of the “medical home” is emerging as an increasingly sophisticated idea, that indeed may promote primary health care access for many of the nation’s most vulnerable persons. What do you see as the promises and the challenges of the medical home as a mechanism for increasing primary health care access? Team 1. L. Burnett (Lead), Babitz, Fernandez, Hansen, Maudlin, TroyFamily medicine revisited:it decreases accessit decreases reimbursementsit is hard to meet performance goals unless “cherry picking” [atoemtscreates “perverse” incentivesMedical home is “designed” to clarify the true role of primary care. It is not defined as care of the “family” – only the patient. It creates a system in which any specialist can be a “medical home”.Community health centers are currently the most effective comprehensive care for underserved communities.Medical home is stated as an effort to save money, but is based on poor data.NCQA medical home tiers of certificationRepacking of “gatekeeper” in a more politically correct manner.CHCs/FMRP Centers. These work most effectively. CHCs will increase in political power as two-tier system becomes legislatively entrenched.L. Burnett, scribe. Team 2 W. Burnett (Lead). Baird, Flinders, Hara, North, Vega The medical home is an evolving concept that many don’t understand.Kaiser has had the Medical Home for decades, especially now with Kaiser’s electronic health record.NCQA payments drive the Medical Home.The medical home can take more effort. For visits, you need a team to help make care efficient (i.e., an MA gives immunizations prior to an order).Kaiser has population disease management systems which manage chronic illness remotely, without a physician being present. It has proven to be cost-effective.Some payers want visit-based care and are closed to new models, such as using e-mail to address patient concerns.The medical home works well in capitated systems. It’s more complex to implement in low-income communities.Access isn’t a natural outcome of Medical Home. Access needs to be addressed proactively.Medical homes have received bipartisan support, and we’ll need to take advantage of that.Team 3 Wilke (Lead), Bejinez-Eastman, Fort, Hines, Osborn, WebsterPromises:transparency, portability of informationefficiency in record-keepingrelationship builds over timequality as an group, individual measureteam approach, with members having an equal visionbetter quality level for all rather than have a few motivated patientrelationship of patients to patients and providers to providersChallenges:obtaining reimbursement for time spent by allobtaining buy-in of all players as Medical Home “members”the financial risk for providing a Medical Homeobtaining equal access for allapplying a small paradigm of care to a larger group of peopleminimum standards for all vs maximum standards for a fewsystem development for task completionhome members training on how to live in “home”receptive approach to patients to have interns in the “home”control of staff behavior Team 4 Herman (Lead), Casey, Fowkes, Kasovac, Palafoxpayment reform has to support the medical homemedical home means changing the way you practiceteam home visits an important part of access Fowkes, scribe.Team 5 Ross (Lead), Coleman, Freeman, Kimball, PeckWill likely not improve access unless system changed, but will improve systems of care for those already “in”.May reduce pressure on physicians and PCP by downloading less complex care to other members of the team in the home, thereby freeing time to increase patient numbers cared for in the home.It may open up other access points for care such as phone and/or computer/e-mail access, but the poor rarely have the access to technology nor the knowledge/sophistication to use this form of access.May be able to take the care to the patients home by using mobile clinics and other innovationsWe will need to improve social responsibility to improve access and care-Josh says: “We don’t care for or about each other in the United States”Ross, scribe.Team 6 Clover (Lead), Erickson, Frey, Lee, PugnoThe fact that Family Medicine (FM) has taken a lead in the Primary Care Medical Home (PCMH) has been lost to the rest of the worldMajor strength of PCMH: it is so well-designed that people like it however they conceive itthe challenge today: the force out there in the workplace not sufficient enough to delivermisconception that PCMH allows for less FM docs for more pateintsnot a more efficient healthcare systemdilemma: we may have created a false misperception with the public that we are not able to fulfillreimbursement will need to support a change in practice to make this successfulother specialties have taken up the PCMH to gain the reimbursement associated with itmany family physicians feel that they are being asked to do more and more without compensationmedical students are expecting this – but do we have a model of PCMH?increased enrollment medical students, but decreased FM residency positionsneed fo increased general Internal Medicine docs as well, but they are dying outAAPA has been great partner with AAFP, but there is no national nurse practitioner group. Whom do we talk to? How do we get good data?AARP in favor of PCMH, but has not been visible with thisbut, we cannot raise public expectations that we cannot deliverpayment levels and bureaucratic rules will determine how successful PCMH will beHow to model PCMH in a Family Medicine Center (FMC), when FMC is not able to make the dollars required to run itPCMH model will deliver primary care [in communities where] Emergency Rooms and “docs in a box” also deliver primary careNeed an enlightened team; PCMH requires abstract thinking, and physicians typically are linear thinkers people found this article helpful. What about you?