Transforming care delivery: Paul Grundy, M.D., president of the Patient-Centered Primary Care Collaborative and IBM's global director of health care transformation, examines progress and challenges remaining on the patient-centered medical home model. He's optimistic both political parties will support this effort to lower prices and boost quality.Where are we in the evolution of the patient-centered primary care delivery model?
GRUNDY: It has gained a lot of traction and I'm very optimistic. The patient-centered medical home moves delivery away from an episode of care and toward managing a population, with the medical home or primary care practice being the system integrator. The federal government as a health care buyer is moving in this direction. The Office of Personnel Management is moving in this direction. WellPoint and UnitedHealth Group UnitedHealth Group Incorporated NYSE: UNH is a managed health care company. It is the parent of United Healthcare, one of the largest health insurers in the U.S. It was created in 1977, as UnitedHealthCare Corporation (it renamed itself in 1998), but traces its origin to a are moving in this direction. It's become the standard of care in the Department of Defense and the Department of Veterans Affairs Veterans Affairs is a term of the business that deals with the relation between a government and its veteran communities, usually administered by the designated government agency. .
How is this affecting provider-purchaser relationships?
GRUNDY: The great thing is that primary care doctors gave us the principles upon which this foundation is built. They wanted to change the covenant around the care we buy as much as we did. It's turning out to be a win-win and there's broad consensus for this.
It's not easy to make the transformation. It's tough to do the three things that we need done at once, i.e., put skin in the game for patients by transforming how benefits are designed, transform how physicians work toward managing a population and paying for outcomes. The other thing we see is that specialists love this model. In North Dakota North Dakota, state in the N central United States. It is bordered by Minnesota, across the Red River of the North (E), South Dakota (S), Montana (W), and the Canadian provinces of Saskatchewan and Manitoba (N). , for example, specialists talk about how the patients they see are much more likely to need the procedures they offer and that their care is managed more efficiently and effectively.
What still needs to change in the care delivery model?
GRUNDY: The most difficult thing that we're asking folks to do is make a cultural transformation--thinking of themselves in the way that every other business except health care does in terms of continuous improvement in efficiency, Six Sigma Not to be confused with Sigma 6.
Six Sigma is a set of practices originally developed by Motorola to systematically improve processes by eliminating defects. A defect is defined as nonconformity of a product or service to its specifications. and Lean. It's also difficult to move from a master builder Master Builder can refer to:
or deoxyribonucleic acid
One of two types of nucleic acid (the other is RNA); a complex organic compound found in all living cells and many viruses. It is the chemical substance of genes. of medicine.
How ore companies like IBM (International Business Machines Corporation, Armonk, NY, www.ibm.com) The world's largest computer company. IBM's product lines include the S/390 mainframes (zSeries), AS/400 midrange business systems (iSeries), RS/6000 workstations and servers (pSeries), Intel-based servers (xSeries) responding to patient-centered core delivery?
GRUNDY: Large corporations in this country are the buyers of care principally for the 65 and younger population. We play a unique role. And, frankly, most of us have been fed up with the value proposition of the care that we buy. We get it when we see a sign on the freeway that says: "We do the best heart surgery." That sign says to us, "That's where the money is and we're going after it." We don't want to buy that anymore.
There are places in this country right now that already have one-third less necessity to do heart surgery because someone has the discipline to manage a population, to do blood pressure monitoring, aspirin therapy and cholesterol control. It's just not in the interest of the hospital given the current value proposition of how we pay them.
How are physicians responding to the population management approach?
GRUNDY: We have early adopters and systems that are definitely embracing it. I was talking with one of the Pioneer ACO ACO Aircraft Certification Office (FAA)
ACO Ant Colony Optimization
ACO Automobile Club de l'Ouest (Le Mans racing governing body)
ACO Australian Chamber Orchestra (Sydney, Australia) facilities in Appleton, Wis., and the CEO (1) (Chief Executive Officer) The highest individual in command of an organization. Typically the president of the company, the CEO reports to the Chairman of the Board. said, "We really want to start being part of the solution and not part of the problem."
Those providers who see themselves as wanting to be part of the solution are on board with this. They're embracing it, driving it and are excited about it. Those that are happy with being part of the problem--i.e., doing as many high-end procedures as they possibly can and doing as little primary care as they can get away with because that's where they make their money--are conflicted.
They're going to have to come to grips with that. Every system is going to have to ask: Do I want to be part of the solution or do I want to continue to be part of the problem?
How will cost and quality change in this new model?
GRUNDY: We're seeing significant improvements in some of the early pilot programs. A report from Geisinger Health System The Geisinger Health System (GHS) is a physician-led health care system of northeastern and central Pennsylvania with headquarters located in Danville, Pennsylvania. in the The American Journal of Managed Care in April shows a significant decrease in cost. In some of the early pilots by WellPoint and BlueCross BlueSkield of South Carolina South Carolina, state of the SE United States. It is bordered by North Carolina (N), the Atlantic Ocean (SE), and Georgia (SW). Facts and Figures
Area, 31,055 sq mi (80,432 sq km). Pop. (2000) 4,012,012, a 15. , for example, we see a 9.6 percent decrease in costs. We see a decrease in the neighborhood of 32 percent in number of deaths. In CareMore, one of the BlueCross BlueShield-WellPoint practices in California, we've seen a 60 percent reduction in the complication rates of diabetics. That's 60 percent fewer amputations, 60 percent fewer people going blind.
What will it take to deliver a more coordinated approach to care?
Let's start at the absolute simplest element--a spreadsheet of data about a population that you need to help. My cat, for instance, has a registry. My cat gets notified when it needs immunizations. It gets notified when it needs preventive procedures. But until recently, most people haven't experienced that in health care because that is not what's reimbursed.
The simplest element would be a registry by which a doctor could gather information about who they see and how they follow up. The next element would be patient engagement. About 60 percent of my employees who saw their doctor when we did this test with Care Partners using a solution kiosk didn't understand what the doctor told them. We need to understand how much of the information we provide is understood and what requires follow-up.
The next step is to understand how to engage a patient differently, measuring that and paying for that. The next step would be coordinated care--seeing your doctor and having a care coordinator follow you with a plan to make sure you're complying. A diabetic doesn't need an episode of care. A diabetic needs a manager, a plan, coordinated care and a reminder to take meds and exercise. We need to engage patients in a very different way.
THE GRUNDY FILE
IBM Corp.'s director of health care transformation for the past 12 years. Serves as president of the Patient- Centered Primary Care Collaborative. a coalition he led IBM in creating in 2006.
Why he joined IBM:
"IBM has the opportunity to do for the doctor's mind what X-rays have done for their vision. Built on that is a foundation of the care we buy as an employer. My current role is to be an advocate for driving health care transformation away from episodic care toward managing a population, and away flora paper and toward data."
Recipient of National Center for Quality Assurance Health Quality Award, March 2012,
To watch a video of Paul Grundy speaking at the TED Conference in Amsterdam, go to www.hhnmag.com.
To listen to a podcast of this interview, go to www.hhnmag.com.