Blog posts

Change is Inevitable; Progress is Optional

By Dr. Evan Saulino

Health care policy talk in America today is littered with language that portends a health care future offering better patient care that is more financially sustainable for Americans. But the definitions, rules, and actual entities behind each of the “buzz-words” are still being shaped in many cases. So it’s critically important to make sure the practical implementation of concepts such as, Accountable Care Organizations (ACOs), Community Care Organizations (CCOs)– a Medicaid relative of ACOs in Oregon, Medical Homes, Exchanges and other ideas – end up as good things for patients and not just as new labels on old product,s or something different that has few positive consequences and too many unintended negative consequences.    

Take the implementation of Medical Homes - or Patient-Centered Primary Care Homes as we like to call them in Oregon (sorry, we like to be different here) - as an example. 

The Medical Home concept was developed originally by Pediatricians back in the 1970s. It is a wonderful model of patient-centered, highly-coordinated care, particularly important for patients who have a lot of physical, mental, and social support needs. The adoption of the model has historically been inhibited by perverse financial and time incentives that pay for quantity of care, not quality of care. But when the Medical Home model is implemented successfully – with up-front investment and provider involvement – it can help ensure better care, higher patient satisfaction, and lower costs to the system overall. This is accomplished through well-coordinated team-based care that is less likely to involve unnecessary tests or visits to the ER. 

However, if there is little or no financial, time, or leadership investment in the Medical Home transformation – if there is a focus on measuring tasks rather than function – if patients are not involved in the process of transformation - this innovative idea is unlikely to produce progress. As a result, the patient interactions and outcomes are not likely to improve.

So even with this well tested model that has the potential to transform care and outcomes and control costs, success will often come down to finances and want for leadership.  So, if we fail to be vocal innovation leaders in our local clinical communities, we could end up with a lot of Medical Homes that look a lot like this.

One elegant model to prevent this and ensure the necessary up-front investment for the Medical Home implementation can be found in Rhode Island.  

But it’s going to take front-line doctors, nurses, and other health professionals to recognize the importance of process and system improvement and to lead innovation in the right direction. We’ll have to stand up as leaders and refocus on the patient – the reason we went into medicine.  It’s through the hard work of collaborative leadership and making our collective voices heard that we’ll be able to make progress, and not just talk of new ideas that lead to more of the same old thing. 

We’re at the cusp of big changes in health care financing and delivery over the next several years. America’s medical system will change because economics and new laws require it.

But the rest of the story is yet to be written.

It’s up to us to help write it. 

Share Your Comments


  1. Let us know what you think!

Your Comment


Join Doctors For America


or skip signup