Jeffrey Krasner had a great article in yesterday’s Boston Globe about his experience trying to manage and coordinate his Mom’s care. As a very experienced health reporter in a city dense with advanced health care delivery and health policy wonks, his story of problems getting care coordinated amongst her physicians and having her medical records transferred is very illuminating. However, for those of us who have spent time trying to help friends and relatives navigate the medical care maze, it is not surprising. (I went through a somewhat similar situation with my Aunt several years ago.)
While some people conclude that the solution to this complexity is a national health system, I believe that creating more standardization and accountability within our existing structure is a much more practical answer. Significant steps have already occurred in that direction in hospital care with checklists for pre and post surgical review, and steps for inserting IV lines into central veins. And of course the Institute for Healthcare Improvement has done tremendous work to improve the quality of care in hospitals across the country with arrays of sophisticated process improvements.
Making Care Coordination Work in the Outpatient World
The challenge is taking the lessons learned from these experiences and successfully implementing them in outpatient settings such as physicians’ offices – which are much more diverse and resource poor. One way to facilitate quality improvement and better care management would be to increase the integration and consolidation of physicians into larger groups, since it has been shown that larger groups are more likely to be able to provide care coordination and management services to their patients.
These concepts are being defined more and more as part of the Medical Home model – which many medical and policy groups are increasingly supporting, (such as the ACP, AAFP, AOA, APA, MedPAC and the Commonwealth Fund), and which I have written about previously. While evidence is still being gathered about how well Medical Homes are performing, and how they should best be structured, consensus is building that they are a practical concept for improving the quality of care, controlling costs, and increasing accountability for the delivery of care. In addition, because of how Medical Homes can place shared responsibility on physicians and patients, and can make providers accountable for clinical and cost outcomes, they should benefit and be supported by patients, physicians, payers and others. And having that many stakeholders supporting any idea is a huge first step towards making significant changes. Of course, making sure that all stakeholders understand what the Medical Home concept means, and how to practically and effectively build and use them, will also be necessary for making them successful.