Military touts medical home care

Most military beneficiaries haven’t heard of PCMH or “patient-centered medical home,” a civilian-conceived strategy to improve managed care.

Yet 655,000 military beneficiaries who use base clinics and hospitals have been enrolled with a PCMH team over the past 14 months and that number is projected to double this year and double again, to 2.5 million beneficiaries in 2012.

The military’s direct care system, in effect, quietly is orchestrating its own major health care reform. And though it didn’t conceive the concept or that mouthful of an acronym, the military might be showing the nation how to embrace PCMH and to clear some of its highest hurdles.

After more than a year’s experience at more than 50 pilot sites across the military health care system, confidence in the concept is rising among health care providers and beneficiaries, reported senior health officials this week at the Military Health System Conference held in National Harbor, Md.

The three service medical departments use slightly different names for PCMH. Sailors and Marines are being told about “Medical Home Port.” Air Force touts a new “Family Health Initiative.” Army has called it PCMH but also “Community-Based Medical Home.”

In every case, beneficiaries use military-run clinics for primary care and are assigned to a doctor, by name, supported by a small professional staff or team. That team is responsible for managing all health care for empanelled patients including specialist referrals when needed.

Patients see familiar faces with every visit, assuring continuity of care. Appointments and tests get scheduled promptly. Care is delivered face-to-face on site or, when appropriate, remotely, using tools like electronic health records, secure e-mails and interactive websites. The same tools guarantee 24-hour health advice. The team encourages healthy lifestyles and it schedules preventive health screening as appropriate for age and gender.

Being shelved is a long-held notion that a military clinic’s effectiveness is best measured by number of patient visits, tests run and procedures performed. The old scorekeeping, say PCMH advocates, does measures care provided and usually protects a clinic’s budget. But it doesn’t correlate to patient satisfaction or levels of health achieved.

What spurred Defense officials to order the services to move toward patient-centered reform was a 2008 beneficiary survey showing users of military clinics markedly less satisfied with their health care experience than beneficiaries using the more costly TRICARE network of civilian providers.

Military commanders noticed too as they fielded a rising number of complaints from stressed families who couldn’t get appointments, had long wait times at clinics and to gain appointments with specialists.

Vice Adm. Adam M. Robinson, Navy’s surgeon general, told conferees Medical Home is not brick and mortar but rather “a philosophic construct of how you deliver care,” emphasizing disease prevention, 21st century communication and using the full talents of entire medical staff.

“It will require us to change how we think. We cannot continue to have clinics (only open) seven to three, Monday through Friday, and holidays off,” Robinson said. He added, “It is truly a game changer.”