In our nation’s capital, the extensive debate over federal health care reform focused attention both on how best to provide health insurance as well as how best to deliver high-quality, affordable health care. One way in which New York State is taking a lead in the latter is by focusing our resources on developing and strengthening primary and preventive care. To achieve that goal, we are encouraging the development and support of the emerging patient-centered medical home model.

The theory behind this model is simple: people who have a regular source of health care services will receive ongoing preventive care and chronic care management rather than episodic, symptom-based, and crisis care. Each patient within a medical home has a relationship with a personal physician and a team of other professionals who coordinate his or her care. This results in more cost-effective care and better health outcomes.

In December, in my role as chair of the New York State Senate Health Committee, I hosted a roundtable on medical homes that brought together a diverse group of stakeholders, including consumer representatives, community health centers and hospitals, physicians, nurses, hospice and home care providers, public and private health plans, and New York City and State government. Representatives from medical homes in rural areas, urban centers, early adapters and those who have been working for over a decade shared their expertise and discussed the challenges of providing care when and where patients need it most.

What we learned was instructive. In practice, successfully implementing the patient-centered medical home model requires years of hard work, the reorientation of health care staff at every level, the embracing of health information technology, and a top-to-bottom change in the culture of delivering care. For this model to work, the health and insurance sectors need to come together to develop a shared sense of priorities and agenda, including shifting from a reimbursement system that pays for particular services or procedures toward one that pays for case-based care management.

We need to retrain our entire health care workforce, including those in behavioral health, so that the transformation of the delivery system is fully understood and realized. Private physicians will require resources, technology and training to reorient their practices and coordinate information technology and electronic medical records. Importantly, health education and patient self-management skills and techniques need to be developed and incorporated into the primary care model.

One of the greatest challenges we face in moving toward the medical home model is the current shortage of primary care providers, which can be attributed, in part, to financial incentives that encourage medical specialization. To address the challenge, New York State’s medical homes initiative provides incentive payments to those practices and providers that are recognized by the National Committee for Quality Assurance. We will also have to increase the use of non-physician providers to meet the need for expanded and accessible primary care.

New York is in the early stages of development and experimentation with medical homes. We are still learning what works, and what will make a difference in the way care is delivered. In the same way that federal health care reform will encourage providers to challenge established models of medical care and delivery, we too must be willing to change the way that we think about health care.

A successful transformation in the culture of medicine to promote health - rather than cure sickness - will not be easy, nor will it likely reap immediate benefits. But long-term, the movement toward accessible, integrated care that patient centered medical homes provide will yield better outcomes for our patients while improving our entire health care delivery system. 


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Thomas Duane, a Democrat representing parts of Manhattan, is chair of the Senate Health Committee.