Tuesday, November 24, 2009

Primary Care Models That Are Outside the Mainstream: Will Health Reform Be Flexible Enough (and disease management see the opportunity?)

Thanks to a combination of colleagues' e-mails*, media outreach and alerts, the Disease Management Care Blog has become reacquainted with some interesting primary care models that aren't in the mainstream of healthcare reform.

They may be worth thinking about.

First off, the Philadelphia Inquirer has this report on an insurer owned and operated primary care clinic. The DMCB recalls that during the 1990's, some HMOs branded and operated their own outpatient networks. With the fall of capitation, the concept fell into disfavor.

Or how about the concept of 'Direct Primary Care,' where, for as little as $49 per month, patients can access primary, preventive and chronic care. If the DMCB understands this right, the DPC folks want to cut the insurer-middleman out entirely and effectively let each patient pay their own capitation. Could this arrangment make limited forms of health insurance a good option and a lot cheaper? This Wall Street Journal editorialist would probably say yes.

There's also the notion of the community based medical home, where a cluster of primary care physicians refer to and rely on a separate network of care management nurses. This is very nicely described in a recent editorial by Helene Levens Lipton appearing in the November 23 Archives of Internal Medicine. A good example of this can be found in Vermont and their shared 'Community Health Teams.'

Once again, the DMCB worries that whatever passes for health reform may not be able to accomodate the primary care work-in-progress. All of the ideas described above have their merits and, for some patients in some markets, may be a perfectly satisfactory option.

Last but not least. the 'community based' feature of a medical home could represent an important opportunity for the care/disease management vendors.

*you know who you are: thanks!

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