Would You Run Your Business This Way? 

Newt Gingrich and James King, M.D.

If the U.S. health care system were a business, it would have filed for bankruptcy long ago.  No company could survive by offering its customers skyrocketing prices, poor quality and limited access.  However, that is exactly what we get in health care today.  
 
Consumers, employers, doctors and policy-makers have had enough. They want change that goes beyond tweaking a broken system. They want dramatic change. A change that replaces today's fragmented, costly paper-based approach with a cohesive, modernized system that improves individual health, coordinates care and reins in costs.

One of the most important changes is reestablishing -- and then improving -- the doctor-patient relationship. Today's system violates this sacrosanct relationship. It squeezes time from every visit, forces physicians to focus on insignificant matters (when compared to the health of their patients) and prioritizes acute-based sickness over preventive health.  Which is a little like an auto mechanic telling car owners that it is better to wait until their car engines seize up than to schedule regular maintenance.

There is a model that can fix these problems, and it goes by many names -- a personal preventive care center, patient-centered primary care or simply the patient-centered medical home.

This model encourages consumers to develop a strong, ongoing relationship with their primary care doctor with the shared goal of improving individual health.

Physicians' responsibility is to provide health services that focus on wellness, to help prevent chronic illness and its complications, and to intervene when acute illness or accidents occur.

In addition to this focus on wellness, another hallmark of the medical home concept is for physicians to help coordinate the services consumers receive in other sectors of the health system.  

By delivering information that follows the patient, the physician's office becomes the "library" that contains the history of the patient's care, from hospitals and subspecialty physicians to home-health agencies and long-term care providers.  

This approach overcomes one of the most inefficient and deadly aspects of the current system: the fragmentation of care where treatment occurs in isolation with virtually no information about a patient's past.

To serve this role, and to truly provide patient-centered primary care, physicians must adopt health information technology. Technologies like electronic health records allow physicians to connect with other stakeholders in the system, share information and better coordinate the delivery of care. It is impossible to do this with paper medical records.   

The use of technology can also track whether physicians are meeting quality measures, promoting the use of evidence-based medicine and utilizing clinical decision-support tools. It can also offer convenience to patients through same-day appointments, group visits and secure online services such as appointment requests, patient history updates and reports of lab results.

Are there results that prove the benefits of this concept? Absolutely. Look at North Carolina's Medicaid program. The state spent $20 million in payments to 3,500 primary care physicians to participate as pilot personal preventive care centers. Through reduced hospitalizations, better control of chronic disease and the reduction of complications, this investment saved Medicaid more than $231 million in 2005 and 2006.  Better health at lower costs.  

The medical home concept can work for business as well. IBM reports that, compared to industry norms, its health care premiums are 6 percent lower for family coverage and 15 percent lower for single coverage since the company implemented patient-centered primary care programs. And the employees? They reported high satisfaction.

These are not mere anecdotes. Since the 1990s, researchers at the Johns Hopkins University School of Public Health and the World Health Organization -- among many others -- have demonstrated that access to primary care delivers better health at lower costs. Primary care reduces death rates for all causes, including heart disease, cancer and stroke; lowers infant mortality rates and low birth-weight babies; extends life expectancy; and lowers total costs of care.

We can only dream of these results with our current system.  It invests in the wrong priorities, pays too much for the wrong services, and delivers poor outcomes. Unlike a private business, health care cannot file for bankruptcy. We have to make it work. Models like the medical home, which improve quality while lowering costs, must be part of the turnaround.     

Former House Speaker Newt Gingrich is founder of the Center for Health Transformation. James King, M.D., is president of the American Academy of Family Physicians. The Academy is a member of the Center for Health Transformation.