By Senator Thomas K. Duane
In our nation’s capital, the extensive debate over federal health care
reform focused attention both on how best to provide health insurance
as well as how best to deliver high-quality, affordable health care.
One way in which New York State is taking a lead in the latter is by
focusing our resources on developing and strengthening primary and
preventive care. To achieve that goal, we are encouraging the
development and support of the emerging patient-centered medical home
The theory behind this model is simple: people who have a regular
source of health care services will receive ongoing preventive care
and chronic care management rather than episodic, symptom-based, and
crisis care. Each patient within a medical home has a relationship
with a personal physician and a team of other professionals who
coordinate his or her care. This results in more cost-effective care
and better health outcomes.
In December, in my role as chair of the New York State Senate Health
Committee, I hosted a roundtable on medical homes that brought
together a diverse group of stakeholders, including consumer
representatives, community health centers and hospitals, physicians,
nurses, hospice and home care providers, public and private health
plans, and New York City and State government. Representatives from
medical homes in rural areas, urban centers, early adapters and those
who have been working for over a decade shared their expertise and
discussed the challenges of providing care when and where patients
need it most.
What we learned was instructive. In practice, successfully
implementing the patient-centered medical home model requires years of
hard work, the reorientation of health care staff at every level, the
embracing of health information technology, and a top-to-bottom change
in the culture of delivering care. For this model to work, the health
and insurance sectors need to come together to develop a shared sense
of priorities and agenda, including shifting from a reimbursement
system that pays for particular services or procedures toward one that
pays for case-based care management.
We need to retrain our entire health care workforce, including those
in behavioral health, so that the transformation of the delivery
system is fully understood and realized. Private physicians will
require resources, technology and training to reorient their practices
and coordinate information technology and electronic medical records.
Importantly, health education and patient self-management skills and
techniques need to be developed and incorporated into the primary care
One of the greatest challenges we face in moving toward the medical
home model is the current shortage of primary care providers, which
can be attributed, in part, to financial incentives that encourage
medical specialization. To address the challenge, New York State’s
medical homes initiative provides incentive payments to those
practices and providers that are recognized by the National Committee
for Quality Assurance. We will also have to increase the use of
non-physician providers to meet the need for expanded and accessible
New York is in the early stages of development and experimentation
with medical homes. We are still learning what works, and what will
make a difference in the way care is delivered. In the same way that
federal health care reform will encourage providers to challenge
established models of medical care and delivery, we too must be
willing to change the way that we think about health care.
A successful transformation in the culture of medicine to promote
health - rather than cure sickness - will not be easy, nor will it
likely reap immediate benefits. But long-term, the movement toward
accessible, integrated care that patient centered medical homes
provide will yield better outcomes for our patients while improving
our entire health care delivery system.
Thomas Duane, a Democrat representing parts of Manhattan, is chair of
the Senate Health Committee.