Dr Roy MacGregor led the judging panel who selected City of Coventry Health Centre from 220 entries. The entire premise of the Medical Home movement, seen most vividly through the efforts of the Patient Centered Primary Care Collaborative (PCPCC), is based, first, on empowering PCPs to do the things they were trained to do, and second, giving them the tools, programs and authority to optimize their roles. The health plans are at the table too, busily showing their support through pilot projects that test what happens when PCPs are paid a pittance more. Their salvation is absolutely vital to re-establishing American health care’s stability and sustainability.
Even that is critically important, though, because the commercial health plans are the linchpins of change for this aspect of American health care. Unlike public health plans, who must adhere to policy that is dictated by the health care industry’s lobby, the commercials can respond to market forces. Our focus on collaboration helps provide better quality care and lower premiums for our patients.
Health plans also are the only ones who can reach and transform the practices of the 250,000 or so community-based PCPs faltering under the lash of our current reimbursement paradigm. But so far as I’m aware, not one national health plan has yet decided to move beyond a pilot and unilaterally improve their medical management performance by paying PCPs significantly more. Nor are health plans systematically helping PCPs acquire the sophisticated patient management information technologies that can result in better outcomes at lower costs.
Health plans have reported weaker enrollment figures, with reductions in the sales of even their much skinnier High Deductible Health Plans (HDHPs), as more employers and families are priced out of insurance. The coverage market is eroding as health costs continue to spiral upward, exacerbated by a credit crisis that is freezing liquidity. The New York Department of Health forbids doctors to publish patient testimonials, while these businesses can.
These economic trends are abetted, of course, by a primary care structure that is unable to exert control over the unbridled provision of specialty and inpatient services. Employers with strength and foresight are actively moving around the health plans by establishing worksite clinics, effectively staff model primary care practices that are fully realized medical homes. Before forming HPSA in 1992, Mr. Laszewski was chief operating officer for a health and group benefits insurer.