OPINION A New Partnership Between Doctors and Patients

An experiment in Plymouth could help point the way to more effective, affordable, and humane health care, while making its delivery more rewarding for both patient and doctor.

Doctors and other providers affiliated with Tufts Medical Center and the New England Quality Care Alliance, working under a grant from Harvard Pilgrim Health Care, are spending this year treating Plymouth patients with diabetes. Primary care doctors, teamed with nurses, social workers, and nutritionists, are making modern medicine a little old-fashioned. Yes, they are armed with modern tools like electronic billing, E-mail, and the full array of medical technology. But, at the heart of the program, the ‘Medical Home’ approach is about establishing a partnership between the patient and practitioners, in a long-term professional relationship that ideally increases the well-being of both.

A primary care doctor, supported by a clinical team, manages all of a patient’s care, allows for same-day appointments, and confers via E-mail or telephone. Instead of having a patient navigate the minefield of health care, the physician creates a partnership with the patient and facilitates the care of the person, not a disease or case number.

In the case of a patient with diabetes, this approach can result in life-saving adherence to proper diet, blood testing, and drug regimens. It can also eliminate costly emergency-room visits and redundant or unnecessary — and costly — scans and tests.

The Plymouth pilot is one of a number of programs nationwide trying to determine whether the Medical Home approach can cure a lot of what ails health care.

Four associations representing 330,000 physicians have endorsed the practice, and the National Committee for Quality Assurance has put out guiding principles for Medical Home practices.

The approach aims to return the doctor-patient model to its roots as a personal relationship. That should mean better health care for the patient, as the primary care physician learns of health problems that go beyond a single issue or episode.

Also for the patient, it means a renewed trust and comfort in the medical system, a trust that should encourage more patients to rely on a professional — rather than the Internet and drug-company ads — for advice and guidance.

For doctors, far too many of whom are unhappy with the lack of prolonged human interaction with patients, it should mean better job satisfaction.

What does it all mean for the bottom line? We don’t know yet.

True, Medical Home would require changes in the ways doctors bill and health insurers pay. We need to start paying for the patient, not just for the patient’s visit. Insurers would have to pay for doctors to consult with patients beyond the 15 minutes in the examination room, and the health care system would have to do more to produce and reward primary care physicians.

Currently, there are not enough primary care physicians to make the system work properly. We need, as a society, to create incentives to encourage more medical students to become patient care quarterbacks at a time when too many opt for lucrative ‘special teams.’

But we can also anticipate rewards that go beyond better health care and increased patient and doctor satisfaction. The state of North Carolina saved $231 million in Medicaid payments over two years using the Medical Home model statewide in a program involving 3,500 primary care physicians.

The Commonwealth Fund reported that “a Medical Home approach could result in net health system savings of $194 billion over 10 years if all Medicare fee-for-service beneficiaries were enrolled. Estimated national savings would be larger if this approach were adopted by all payers.”

If it works, hospitalizations, emergency-room visits, and unnecessary scans and tests should decrease for the patients in the pilot program in Plymouth. If successful, the approach should save money because diabetics who regularly test their blood and eat healthy and exercise are less likely to become catastrophically ill. If it works to keep diabetic patients healthier, it may also work to keep more patients from developing chronic conditions in the first place.-

Ellen Zane is CEO of Tufts Medical Center. Jeffrey Lasker is CEO of the New England Quality Care Alliance, a network of more than 600 physicians based in Braintree and affiliated with Tufts Medical Center. This article first appeared in the Bost

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