A few days ago I received an email from a general internist about my posts about concierge practices. I have known this physician for over 20 years, and he has great insight into the challenges facing health care. This email was no exception; he had this to say how his group took the “middle way” of pursuing private funding for the Patient-Centered Medical Home (PCMH):
“My practice includes 3 primary care physicians and has invested heavily in IT infrastructure. We have re-engineered our workflows and have achieved benchmark levels of quality and service. We have won NCQA certification for our PCMH. Yet so far no payer has stepped up to underwrite our investment. So we have joined Privia Health in forming a ‘membership practice.’ Patients are asked to pay a small monthly membership fee. In return they receive some special attention . . . Plan sponsors and payers are invited to pay the fee on behalf of their employees. . . Patients like having same day access. They like secure email communication with their doctor. They like having a personal health record. They like having a case manager helping them navigate the system. And they like going online in the evening to make their own appointments. ACP policy supports the medical home but is silent on the question of what a medical home is to do before local payment realities catch up. I owe my patients my efforts to assure that when I retire an eager young internist will welcome the opportunity to take over my practice. Absent public or private funding for the medical home that is just not going to happen.”
This good doctor is absolutely right—“absent public or private funding for the medical home [it] is just not going to happen.”
In my view, it is a damning indictment of the health insurance industry that even though this physician’s practice has re-engineered its workflows, invested heavily in information technology, achieved benchmark levels of quality and service, and won NCQA certification as a PCMH—everything that primary care practice are being asked to do by payers!--not a single one of them has stepped up to underwrite the investment. This, despite the fact that dozens of health insurers are listed as members of the Patient-Centered Primary Care Collaborative, a coalition of “major employers, consumer groups, patient quality organizations, health plans, labor unions, hospitals, clinicians and many others who have joined together to develop and advance the patient centered medical home.” (ACP is a founding member of the Collaborative and sits on its governing board.)
Now, I anticipate that health insurers will cry foul about my blanket indictment of their lack of support for primary care practices. They will, with some legitimacy, point to the 27 multi-payer pilots in 18 states that are being supported, at least in part, by health insurers. I wonder, though, how many of those pilots are paying the practices anything close to what it really will take to restore primary care as a viable practice model and to reduce the inequities in primary care compensation compared to other specialists. Not many, I expect.
In a couple of weeks, the Patient-Centered Primary Care Collaborative will be hosting a “stakeholder’s meeting” billed as PCMH: A Foundation for Transformation and Reform. I imagine that many health insurers will be at the meeting to talk about all of the wonderful things they are doing for primary care. And some of them, no doubt, believe that they are making things better. But the fact remains that primary care is in crisis, and not enough health insurers--and for that matter, government and employers--have demonstrated that are willing to put their money where their mouth is.
Enough with the happy talk by well-meaning people at yet another conference about how they really care about primary care when the facts on the ground suggest otherwise. Instead, I have just one question for them: when will they really do something real to save primary care?
Today’s questions: Do you think the insurance industry is really committed to saving primary care? And yes, I’d love to hear from the insurance companies). And if not, what can be done to get them to step up and put their money where their mouths are?