The Patient Centered Medical Homes and Wellness: Can Physicians Really Respond?

Check out this '...but I wouldn't want to live there' posting in the Turn to Stone blog. You might be inclined to dismiss this as another off beat critique of the Patient Centered Medical Home (PCMH), but this one is from Robert Stone. Bob is not only an experienced health care executive with years of experience in population-based care management, he's also a co-founder of the disease management company Healthways. When he speaks, the Disease Management Care Blog has learned to listen.

He raises some good points:

• 'Wellness' activities such as exercising and pursuing a healthful diet have yet to be intelligently 'medicalized' in any meaningful fashion. Consumers don't look to their local hospitals and doctors for wellness. What's more, hospitals and doctors don't have the resources (and in many instances the knowledge) to provide wellness services. Last but not least, retooling the overwelmed primary care system to adopt wellness in their busy clinics is a stretch.



• It is doubtful that today's average physician wants to be in the wellness business. After four years of medical school and additional years of postgraduate training, they are trained and socially conditioned to diagnose and treat disease.

Supporters of the PCMH would point out that their care model doesn't rely on the physician personally providing the services. Rather, their job is to be 'doctors' while simultaneously overseeing a team of health professionals that support wellness and prevention. Unfortunately, that key concept may be getting lost as the 'medical home' enters the mainstream. Early buyers of 'medical homes' may be disappointed when they're met at the PCMH door by Nurse Marcia Wellness instead of Doctor Marcus Welby.

The Disease Management Care Blog is more alarmed by Turn to Stone's second point. If docs haven't had a lot of personal professional experience to intelligently deal with nutrition, exercise and all the other forms of non-traditional medical consumerism, how in the world are they supposed to supervise it?

The answer may be to totally 'outsource it.' The DMCB wonders if docs will be inclined to do that and if companies such as Healthways will be able to serve that market.

Time will tell.