Forget the Patient Centered Medical Home…I Want A Patient Centered RV!

Thought you might find this interesting


America is mobile. No, I’m not referring to the mouthful of statistics about how experts estimate there to be more than 500 million mobile health users by 2015, and the global market to grow to nearly $60 billion by 2018. What I’m talking about is how Americans view the world. Outside of conflict ravaged regions, Americans are one of the most mobile peoples in the world. Three-quarters of Americans move on average every five years and the average American moves between 11 and 14 times in a lifetime. So, how does this relate to health information technology and mobile health?

Well, the latest buzz phrase to go around is that of the Patient Centered Medical Home. Often coined as the “future of healthcare,” the PCMH model is thought to have the ability to lower costs, improve care and reduce medical errors through better care coordination and  patient-centered focus. However, as with many new ideas, it’s actually not so new. The idea was first discussed as far back as the 1960’s as a better way to take care of complicated, pediatric patients and was emphasized once again during the HMO-boom of the 1990s.  So, what’s wrong with giving a coordinated and effective effort to actually capitalize on its supposed benefits?

Absolutely nothing, and it is overall a well thought out concept. The problem lies in its current mode of execution and implementation that mimics many of the same errors that have hampered its widespread use previously. For example, nearly 4,000 primary care physicians in Michigan have already been signed on to participate in medical homes, and Blue Cross and Blue Shield is expected to add 1,000 more in the coming months. Given the current IT paradigms, however, this has meant further consolidation through top-down hospital-driven IT projects.

Hospitals are funding the widespread onboarding of thousands of physicians into their EHR silo which rarely has the ability to transmit or share data out of network electronically. What all this means is that while the patient remains in a relatively small geographic area, the patient has a patient-centered medical home. Once that new job or life event takes him or her to a new location or over to a competing healthcare system, the patient is often times “medically homeless.” In a country wherethe average citizen moves over a dozen times, this can mean numerous tests and repeated imaging for a complex patient.

While calculating the sheer magnitude of these potential expenditures is difficult, one can assume it may be quite large as 40 million Americans move each year alone. Just as we saw with HMOs during the 1990s, intra-network savings doesn’t necessarily lead to overall healthcare savings. Patients will require longitudinal coordinated care and will not necessarily benefit from five years in a patient-centered,temporary medical shelter. Increased savings and improved health are complex, cumulative and time-intense metrics, and any estimation or extrapolation of them to the country at large should be studied cautiously.

Since PCMHs and their related ACO counterparts are often federally funded and incentivized, it makes sense to determine what will bring the greatest savings to the country as a whole rather than just its individual parts.  In my opinion, that would be a patient-centered medical RV. The core concept of PCMH remains, but the fundamental difference lies in the ownership and control of the data. In the RV model, the patient has the freedom to take his or her health information in a neutral, electronic format.

While naysayers and industry insiders will often point out technical limitations, infrastructure difficulties or a lack of integrating technology, there are numerous examples of effective cross-platform data sharing models. Health Level 7 (HL7), for example, has well regarded standards for data packaging, processing and transfer. Rather, the fundamental obstacle to overcome is that there is inherent value in proprietary medical information, whether it is from pacemakers , EHRs or medical apps. Convincing these private companies to share this data will be quite a formidable task. However, by doing so, the American people will be able to truly experience the potential value that is  often discussed in relation to medical technology and, specifically, the patient-centered medical home model of care.

In my mind, this aspect will truly create patient-centered care as compared to network-centered care. Whether this will ever be incentivized or required at the national or state level remains to be seen.

Featured image credit: Bill Ward’s Brickpile via cc