There is a concept in healthcare of the "patient centered medical home," defined by the following important characteristics:
- Comprehensive Care
- Accessible Services
- Patient Safety
While I agree with, and even embrace these concepts, the method by which the current system does this is backward: it legislates changes that doctors and hospitals should adopt and then coerces those changes through financial "incentives." I put the word incentives in quotes because most physicians feel that these types of programs ultimately result more in lowering payment for those who don't comply than rewarding those who do.
Regardless of this, I believe direct primary care does this type of thing as the natural extension of who we are. We are clinicians who want our patients to be healthy and who don't have the bureaucratic drain on our time so we can actually accomplish this sort of thing. Here is how my practice meets those guidelines (adapted from a blog post I wrote on the subject):
- Access: My patients will have access to me. They can talk to me when they want, and can access me via secure online messaging or in person.
- Personalized care: We talk to our patients, answer their questions, and tailor the care to their needs. The setting removes the depersonalizing force of the third-parties (which is the main reason PCMH won't succeed if pushed by payors) and allows people to build a plan that helps them meet the main goals they want: to be healthy and to have a high quality of life.
- Continuity: One of my top goals is to build a shared medical record with my patients that will allow them to have their records with them wherever they go. We take the time to communicate with specialists about the purpose of consults, and call to follow-up with patients.
- Self-Care and Community Support: I was initially afraid that giving such easy access to me would create patients who wore more dependent on me for their care. The opposite is actually true: they are far more able to do self-care when they know they can ask me when they have questions. I also am working on an education library that will give them the tools for self-care.
- Track and coordinate care: I see this as my main task. I don't give most of the care, I just help people get hooked up to the resources they need. Online contact will be the main vehicle for this, but I'll use whatever means necessary.
- Measure and Improve performance: for my patients, the main measures of my performance are time and money. How much time are people spending at specialists, ER's, or in the hospital, and how much money are they spending on their care in total? If I can keep people healthy and away from the system, I will be improving the lives of my patients in both physical and financial ways.
I also plan on getting a team of caretakers to help with patient care, including dietary education, exercise, pharmacy oversight, and psychological/emotional support. Doing this will do two things positive for my business model:
- It will improve the overall quality of the service I offer, increasing patient loyalty.
- It will allow me to grow the panel of patients more, increasing income for the practice.