The New England Journal of Medicine recently published an article by Matthew J. Press, MD, about the need for patients to have a quarterback to coordinate the team of care-givers. Dr. Press writes –
Care coordination is now a high priority in health care and is the backbone of new models of care, such as accountable care organizations, that aim to improve quality and reduce costs. But it remains an abstract concept to many people who are not on the front lines of clinical care, as well as to some on the front lines who lack (or don’t want to have) the quarterback’s view of the field. In replaying the highlights, we can learn some important lessons about care coordination.
He emphasizes the importance of personal relationships, both with the patient and with the other providers of care. “But,” he writes, “some changes in health care may be causing relationships to deteriorate. EMRs and the use of hospitalists probably have led to fewer personal interactions among physicians.”
Dr. Press was able to spend a great deal of time building relationships with his patient’s specialists because, “as a clinician-researcher, I had a patient panel about one tenth the size of the average primary care panel.”
He may not realize it (he doesn’t mention it), but he has just endorsed “concierge medicine.” Concierge physicians (they prefer the term “direct practice” these days) model their practices on having a smaller caseload, thereby knowing each patient very well and having the time to coordinate the work of all of the other professionals involved. And the number of concierge physicians is exploding under Obamacare.