Healthcare IT is the essential front-end investment for organizations participating in the patient-centered medical home (PCMH) initiative, according to a new report released by the Deloitte Center for Health Solutions. 

The report, "Medical Home 2.0: The Present, The Future," reviews several PCMH pilots and provides insights on the future evolution of the medical home. It highlights the expansion of medical home pilots as part of the Patient Protection and Affordable Care Act of 2010 (PPACA) to help reduce costs and improve population-based health by leveraging clinical information technologies, care teams and evidence-based medical guidelines.

The report concludes that the medical home will likely be a permanent, near-term fixture on the U.S. healthcare landscape due to rising health costs, an aging and less healthy population, payment reforms that are shifting volume to performance, and increased access to clinical information technologies.

One of the joint principles of the PCMH is integrating and coordinating care, which is facilitated through health IT. Information technology is also a foundation of patient care, performance measure, communication and patient education, which fall under the principle of quality and safety, according to the report.

Key findings from the Deloitte report are:

• With significant investment, the PCMH yields results. The report indicates that IT start up costs can be significant because of fixed technologies costs. However, if organizations can make the initial investment, pilot data suggests that patient outcomes improve and costs are lower with PCMH implementation.
  
• Physician adoption is a major challenge.  Among the core competencies required of PCPs to effectively participate in medical home models include willingness to use health information technologies in diagnostics and treatment planning and routine patient interaction, the report says. 
• HIT is the essential front-end investment. In order to facilitate access, monitor and coordinate care these investments are necessary: EHRs, broadband transmission, personal health records, decision support and web-based services to facilitate access, care coordination and monitoring are necessary. Organizations should expect to make significant investments in IT that may require assistance with purchase and implementation, the report finds.
• Access to an adequate supply of primary care service providers is an issue. Recent reports estimate that PCPs account for 35 percent of the U.S. physician workforce and by 2025, the country will face a 27 percent shortage of adult generalist physicians. The report suggests, among other things, increasing e-visits and distance/telemedicine as ways to help bolster the practice of primary care medicine.

According to Deloitte’s 2010 Survey of Health Care Consumers, respondents are receptive to the use of technologies often leveraged in the medical home model to enable self-care:
      

• Almost half of consumers (49 percent) are interested in using an in-home medical device that could help them know what to do, and when, to improve their health or treat a health condition.
• Baby boomers are most interested in in-home monitoring devices (56 percent), compared with senior citizens (48 percent), Generation X (46 percent) and Generation Y (42 percent).
• Generation X (22 percent) and Generation Y (23 percent) consumers say they are very interested in using a mobile device to maintain their personal health records (PHRs), compared with 15 percent of baby boomers and 17 percent of senior citizens.