The patient medical home: A broader perspective

Jul 20, 2017

On June 19 and 20, family doctors and various Ministry of Health, health authority, and Doctors of BC representatives gathered for the GPSC Spring Summit, which focused on progress and future steps toward establishing the patient medical home in BC. Keynote speaker Dr Paul Grundy, IBM’s Chief Medical Officer and Global Director for Health Care Transformation, kicked off the event, sharing his perspectives on the international emergence of patient-centred medical homes as the foundation for primary care transformation. While sharing encouraging examples of work happening in other countries, Dr Grundy commended BC doctors and their partners for the progress they’ve made and their contribution to worldwide learning on primary care transformation. A summary of key themes of Dr Grundy’s remarks are below. 

Work in BC is part of an emerging worldwide trend built on early and continuing success

Dr Grundy described the patient-centred medical home as a “wonderful experiment” that is unfolding in several US states, Canadian provinces, and other parts of the world, from Denmark to New Zealand.  And the concept is working. He cited a large pilot project in Michigan that, among other gains, quickly demonstrated a 15% decrease in adult ER visits, (click here for more). “We thought it would take two to three years to show savings, but we showed them within the first year,” he said. “After six years of data, we are beginning to see a series of results that are successful year on year.”  

A second example from Vermont described the remarkable success of a team-based experiment in several communities where pharmacists, community coordinators, and other providers worked to coordinate care and create a network of support that wraps around patients. This work led to a 60% reduction in blindness, amputations and other complications among diabetic patients. 

He also spoke of ongoing innovation and shared examples from Jersey, England, where postal employees stop in daily to check on the frail elderly and patients discharged from hospital; and New Zealand, where emergency service workers are providing other services. He encouraged doctors and partners to consider where and how they might repurpose existing resources in their communities to support the patient medical home.

BC is on its way and should celebrate success to date

Dr Grundy acknowledged the hard work ahead but considers the BC patient medical home model “one of the best examples [he’s] seen of putting the pieces together,” indicating that BC partners are “thinking through this in a profoundly powerful way [that is] worth sharing with the world at large.” He spoke to the strength of the BC landscape, where significant social infrastructure is in place that enables partners to consider how to integrate a patient medical home into communities, and sees much of what has enabled success elsewhere happening in BC.

He commended the collaboration between government and doctors, noting that BC is second only to Ontario when it comes to aligning its primary care system with the patient medical home model. 

Family doctors are central to integrated care   

Confirming a core belief and message of the GPSC, Dr Grundy stressed that primary care providers are central to integrated care in all health care systems.  He reminded family doctors that “there is no system of care that works very well in the world without you as the foundation of that system,” and spoke of the “immense responsibility” of “nurturing a longitudinal, lifetime relationship of trust between you, the healer, and the patient.”

Reflecting on the patient-centred primary care delivery system envisioned, he said, “Call it what you will – [we’re working toward] a place where the healer in somebody’s life is the fundamental foundation of the delivery system, is the system integrator, and the place that accountability occurs from across the community into the primary care practice.”

Change must be physician-informed and physician-driven 

Dr Grundy noted that the examples of success he had shared were a result of making changes rooted in a common set of principles and priorities that came from doctors themselves—and also make up the attributes of the BC patient medical home—and by asking physicians, “How can we support you to drive change?”  

If imposed or legislated, efforts will fail, he said. Instead, he advised, “reach out to primary care doctors. Ask them, ‘How can you change your practice? You tell us what you want to do.’” 

To his physician colleagues he stressed the need for “a real sense of ownership of this journey by you, the healer. You need to stand up and say, ‘This is important for me and for my patients.’”  

Key enablers are integral to success

Dr Grundy identified and elaborated on some key enablers for the success of patient medical homes, including payment reforms, use of data, improved communication, and tools for physicians. 

On payment reforms “If you are going to change the way practices practice, if you ask them to stop episodes of care, you need to change the way you pay them.” 

On use of data: He pointed out that for the first time in history, data – with a human interface – can be used to proactively manage patients and customize population care down to the patient level. “Data is going to do for your minds what imagery and X-rays did for your vision.  It’s going to make it much clearer what’s happening.”  

Improved communication/patient engagement: Providers can combine face-to face human interaction with tools such as mobile technology to better understand behaviour and stimulate patients to follow advice. “I was in a remote village in Norway, with a patient sitting in her pajamas talking on her iPad to her psychiatrist 300 miles away.”  

On technology: “Health care is one of last industries where we are supposed to remember everything. That’s changing now. There will be access to data across the team, with the expectation that every person will have a plan – as simple as a chat, or a complex plan. We are literally going to be managing the population down to the individual.” 

On mechanisms for care coordination:  Smooth and efficient care coordination is closely associated with clinical quality. Ideally, “there are only two things you should do as doctors: difficult diagnostic dilemmas and relationships.  Everything else should be done by somebody else on your team.”

While such tools are key enablers to success, they do not supersede relationships.  Tools must support and enhance—rather than replace—the relationships that are vital to the work to transform the primary care system through the patient medical home.   

The path ahead

Bringing his broader perspective as an international ambassador for patient-centred medical homes and care, he described the move toward this model as a “social change; a tipping point” and encouraged partners to be patient, reminding them that primary care transformation is “a journey and it won’t happen all at once.”

“It’s really exciting what you are doing,” he said and encouraged partners to “recognize and share early assurances of success at every level.”