As I have followed the healthcare bills that have gone through Congress, and having analyzed (and still analyzing and sifting…) the many provisions contained therein, I have found that there really are some good “nuggets” which will begin to lay the groundwork for health system change in our country. Besides a focus on the healthcare “insurance” industry, there are provisions which aim to tackle the issue of rising costs and increasing the quality of care.
Tucked into the health care bill which was recently signed into law is a relatively little-known provision that could lead to one of the most significant health care reforms in decades, reducing costs while simultaneously increasing access and quality.
Section 10104 of H.R. 3590, the Patient Protection and Affordable Care Act of 2010, states that the secretary of the Department of Health and Human Services “shall permit coverage in the exchange to be offered through a qualified direct primary care medical home plan.”
The upshot is that this provision essentially enables individuals who shop in the insurance exchanges to elect an alternative to traditional insurance plans in which patients and / or employers pay a flat monthly fee directly to a primary care provider for all primary and preventive care, chronic disease management and care coordination throughout the entire health care system. Under the new law, a flat-fee direct primary care medical home membership, which may start out as low as say $49 per month, and acts much like a gym membership, can be bundled with a new, lower-cost “wraparound” insurance plan that covers unpredictable (and catestrophic) services. Thus, under this type of model for primary care service delivery, the need for an insurance carrier to act as a third party intermediary is eliminated, and the primary care provider is paid directly. The result would serve to simplify burdensome administrative processes and to lower costs in this venue of care. About a third of all states have this in some shape or form as a viable model.
Prior to the Healthcare Reform Bill passage and earlier this year, the Military Health System (MHS) on the direct care side, instituted a policy which requires the implementation of the ‘Patient-Centered Medical Home’ model of primary care in its Military Treatment Facilities (MTF’s). While, the provider reimbursement issue is obviously not a factor, the model’s concept of care delivery is a quality and access improvement.
According to the policy, it’s implemetation is intended to provide for a comprehensive primary care model which will improve patient satisfaction and outcomes. The MTF’s are therefore encouraged to utilize innovative approaches that are patient-centered and access focused. Open access scheduling, online appointing and online provider/patient communication, 24 hour nurse advice and triage lines, and provider/patient telephonic consults are examples of some of the innovative approaches that will hopefully be used to enhance patient-provider communications.
So if we look into the future, this single short provision, may indeed be one of the best-kept secrets of the new law. It may not only ensure that health care will be available to people of modest means, employed by small businesses and currently the uninsured individuals, but it has the potential to completely change the way primary care – and insurance- is delivered and paid for. This is something to look for in the next round of TRICARE contracts!
