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Tuesday March 9, 2010
Health Reform Report June 25, 2009, 5:00PM EST

The Family Doctor: A Remedy for Health-Care Costs?

How making primary-care physicians the center of America's health-care system could drive down costs

By Catherine Arnst

The primary-care doctor is gaining new respect in Washington. Battles may be breaking out left and right over the various health-care bills emerging from Congress, but reformers on both sides agree that general practitioners should be given a central role in uniting the fragmented U.S. medical system.

This vision has a name: the "patient-centered medical home." The "home" is the office of a primary-care doctor where patients would go for most of their medical needs. The general practitioner would oversee everything from flu shots to chronic disease management to weight loss, and coordinate care with nurses, pharmacists, and specialists. A 2004 study estimated that if every patient had such a home, the resulting efficiencies might reduce U.S. health-care costs by 5.6%, a savings of $67 billion a year.

Instead, most patients today get a scant seven minutes with a general practitioner, who has time to do little more than ask cursory questions and focus on the problem at hand. The patient rushes to specialists for chronic conditions that could be managed by a regular doctor. (Today, these different physicians rarely coordinate.) Last-minute appointments are almost unheard of—one reason patients with minor complaints flock to already crowded hospital emergency rooms.

This medical home may sound like the "gatekeeper" model of the 1990s, a managed-care creation that was all about holding down costs. But advocates say the new concept is designed to help patients, not insurers. It's more like doctoring 1950s-style, when a Marcus Welby figure handled all the family's medical needs. This time it's juiced up with digital technology.

It also represents a politically painless way to streamline a disorganized and wasteful system that chews up a crippling 18% of the U.S. gross domestic product. That burden is felt particularly by private industry, which covers 60% of the nation's insured. Since most businesses try to ferret out waste and disorganization in their own operations, the medical home is a concept they can embrace in good conscience.

One of the biggest advocates is IBM (IBM), which shelled out $1.3 billion last year on health benefits for its U.S. employees and retirees, equal to one month of the company's net income. Dr. Paul H. Grundy, 57, who holds the unusual title of director of health-care transformation for IBM, is a medical-home evangelist who led the company to start the Patient-Centered Primary Care Collaborative, a coalition of some 500 large employers, insurers, consumer groups, and doctors. Part of his goal, he says, is to show that "employers can drive the medical-home idea as buyers of care."

Four medical societies have also endorsed the concept, and pilot programs are under way in several states. Most significantly, the idea has the imprimatur of President Barack Obama, who has said any health-care bill should "encourage and provide appropriate payment for providers who implement the medical-home model."

The current practice of medicine in the U.S. is a long way from this model. One recent study found that only 27% of physician practices come close to qualifying as a medical home. Still, for a real-world example, step into a nondescript building in Newport News, Va. There, Dr. Peter B. Anderson is examining Gretchen Parker, 72, his patient for 25 years. A year ago, Anderson warned Parker she was pre-diabetic, a condition that afflicts 57 million Americans. Instead of putting Parker on medication, his team helped her change her lifestyle and lose 55 pounds. Her blood sugar readings are now back to normal.

Anderson next examines a 46-year-old shipbuilder with a husky voice, the result of a three-pack-a-day, 30-year smoking habit. He quit last year—on Anderson's advice—and today he's in for a three-month checkup.

Later Anderson attends to an assistant high school principal and her 16-year-old son.

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