New Concepts in Health Care Delivery

The Affordable Care Act recently signed by Obama might significantly change the way medical care is delivered, at least by primary care physicians. Patient-centered medical homes (PCMH) will give qualified primary care doctors the responsibility to coordinate the patient’s care. It emphasizes a team approach and a shift from routine specialty care to family docs and pediatricians. Pilot projects have shown great savings by better preventive care, fewer hospitalizations and less testing. Our practice is in the process of becoming certified as a PCMH. PCMH patients will still have the choice between conventional and alternative medicine. Accountable Care Organizations (ACO) is another approach being encouraged by the government. ACOs pay the same total amount per patient to hospitals, specialists and primary care docs, which is then split among the participants. This smacks of socialized medicine, while pitting hospitals and docs against each other in competition for payment.

ACOs sound like a recipe for disaster. Finally, some groups of docs on their own have set up Direct Primary Care Models, which have some similarities to the PCMH but they eliminate insurance companies as middle men, except for high-deductible catastrophic care. Patients pay a flat fee directly (typically around $100 a month) to get unlimited access to their family doctors. A lot more prevention is done with longer office visits. ER visits and hospitalizations have been reduced significantly with Direct Primary Care. This might be something we could consider for the future.