Dartmouth Medical School professor Elliott Fisher advocated that Congress integrate two models of health care delivery reform that are generally discussed separately in an article published last week in the New England Journal of Medicine.
"[The report] will be used to educate policymakers and providers about the need for both reforms," Fisher said in an interview with The Dartmouth.
Fisher, the director of The Dartmouth Institute for Health Policy and Clinical Practice's Center for Health Policy Research, co-authored the paper with Stephen Shortell, dean of the School of Public Health at the University of California, Berkeley, and Diane Rittenhouse, a professor of family and community medicine at the University of California, San Francisco.
The article, "Primary Care and Accountable Care Two Essential Elements of Delivery-System Reform," discusses how patient-centered medical homes and accountable care organizations, two models of health care reform that are generally considered individually, are actually complementary to each other.
"The paper was written because some members of the policy community and many members of Congress saw them as competing reforms, and so we were motivated a group of us who were involved in the development of each idea to come together and explore what we believed to be true: that they were complementary reforms," Fisher said.
The patient-centered medical home model involves establishing a partnership among practitioners, patients and their families and places a greater emphasis on primary care, according to the article. Accountable care organizations, networks of health care providers that can provide a full range of medical care for their patients, focus largely on specialists and hospitals, Fisher said.
Shortell, in an interview with The Dartmouth, said he hopes the Centers for Medicare and Medicaid Services will implement programs featuring an integrated system of patient-centered medical homes and accountability care organizations should a health care reform bill be passed.
"Medicare will have a number of these demonstrations go on and if they have the intended effect, the thought is to have a number of them throughout the country," Shortell said.
Fisher said he is optimistic about the article's potential impact on the health care reform bills currently being reviewed by Congress, citing his earlier efforts to promote accountable care organizations as a model for health care reform.
"With our [accountable care organization] work, we've gone from not being accepted by anyone to being integrated in the bills in both the House and the Senate," Fisher said.
Alain Enthoven, professor emeritus of management at Stanford University's Graduate School of Business, said in an interview with The Dartmouth that he agrees that the patient-centered medical home system is important when integrated into a broader system. Enthoven was not involved with Fisher's paper.
"I think that patient-centered medical home, which is a primary care construct, is an important step in the right direction, but I think to get the important quality and cost improvements, you need to tie this into an integrated, comprehensive care system," Enthoven said.
Enthoven said that the integration of specialty care providers' expertise can also improve the quality of patient care.
"The best model is, when we can get there, a comprehensive integrated delivery system," Enthoven said. "The accountability care organization should have as an important foundation the patient-centered medical home, but it also has to have tied into it specialty care."
