aul Grundy, director of health care technology and strategic initiatives for IBM Corp., believes employers have finally found a way to give employees the kind of medical care that keeps them healthy rather than treating them only when they’re sick. The patient-centered medical home, which pays primary care doctors more to provide better preventive care for patients, is being embraced by employers across the country through an effort launched by IBM. The Patient-Centered Primary Care Collaborative includes such employers as Caterpillar, Delphi Corp., General Mills Inc. and General Motors Corp. Mr. Grundy recently spoke to Jeremy Smerd of Crain’s Benefits Outlook.

    Crain's Benefits Outlook: Is the patient-centered medical home a hot new trend in medical benefits?

    Paul Grundy: I think it's the hottest, personally.

    CBO: You said medical homes address fundamental problems with the health care system that employers have largely ignored. What do you mean by that?

    Mr. Grundy: I can buy a damn good amputation for my diabetic, but what I can’t get is a good system in place to prevent my diabetic from needing the amputation. We don’t reward a system in which comprehensive coordinated care and robust prevention is valued. We have no new docs basically going into family medicine—or very few—because not only is it not economic but they’re treated like dirt. They are really demoralized. What they can provide doesn’t seem to be valued.

    CBO: Talk a little about what kind of change medical homes represent and what IBM is doing about it?

    Mr. Grundy: Each patient has an ongoing relationship with a personal physician. It’s a team approach. The personal physician leads a team of individuals who provide care. It’s comprehensive. The personal physician is responsible for everything. It’s coordinated. There is quality and safety in place. There’s technology—the electronic medical record, and evidence-based decision making that’s underneath this. It expands access. It allows a doctor and a patient to encounter each other. They can interact over the phone and e-mail; they have open access.

    CBO: Open access meaning they can come in any time?

    Mr. Grundy: That’s right.

    CBO: How do you take an employer through the process of implementing this model?

    Mr. Grundy: There are multiple ways of doing this. There are many employers already doing this. And it’s relatively easy to do if you buy care yourself. Harrah’s in Atlantic City, Reno and in Las Vegas [have] set up clinics around those towns available to their employees and dependents. And that is where they go to get primary care. They hire physicians and they pay them competitive wages to provide comprehensive coordinated care with electronic medical records. That’s a medical home. And I would describe that as a closed system because it’s not open to everybody.

    Denmark is an example of a country that has transformed itself entirely into a medical home model. They have the lowest medical error rate in the world and highest satisfaction and they have absolutely connected care. I mean you can go anywhere in Denmark and you can engage with your primary care physician no matter who you see. Because he’s in the loop—technologically and socially connected.

    CBO: What is IBM doing?

    Mr. Grundy: IBM made the decision—a difficult decision—that we wanted to transform not a site around some of our plants, but we wanted to transform the whole system and buy this for every employee in every ZIP code. We have 605 of our employees that don’t work in any concentration at all; they work all over the country. So ... though we do have large concentrations of employee populations, we decided at a very high level that we really wanted to change this across the ecosystem. We formed the Patient-Centered Primary Care Collaborative. We’ve got all of primary care engaged. We have all national health plans engaged. We have 70 million lives of large employers plus many large unions and not-for-profit consumer groups engaged.

    At the local level, where we do have a concentration of patients, we are working with physician organizations and third-party administrators to roll out a community-based medical home open to anybody. In the mid-Hudson region [north of New York City], we have close to 100,000 lives. The physicians will deliver robust primary care to anybody who lives here. It’s a transformation of a community practice, not just to employees. We use the same doctors that everybody else in the mid-Hudson uses. We’re trying to transform the level of care for all patients.

    CBO: How does it work?

    Mr. Grundy: We try to incent the docs to give them a system of rewards around stepping up to the process, to getting the technology that would empower them to do this [kind of practice]. [We tell them:] "We will pay you differently. We will reward you for delivering services differently. And in return, you need to transform your practice and deliver more integrated comprehensive care."

    CBO: Are you designing benefits to create incentives so they take advantage of the medical home?

    Mr. Grundy: The medical homes don’t exist yet. The doctors are just in the process of transforming their practices. They're being built now, and when they’re built we’ll design processes to encourage employees to use them. We’re looking at paying first dollar for primary care, for example. We could make a decision to build it tomorrow for our employees—hire a doctor. It’s much more difficult to change a community than trying to build a facility at your plant.

    CBO: Some companies have done that—built on-site clinics, right?

    Mr. Grundy: Exactly. That’s not as complicated as trying to change the system where you have multiple payers. What's unique in the mid-Hudson and the other pilots that are rolling out across the country is that it isn’t a single payer. [With] a single payer, you have the money and you declare it so. Here you've got all the plans, everybody at the table, and all agreeing we’re going to do this.

    CBO: Are any of the projects seeing cost savings?

    Mr. Grundy: Certainly in a closed system there was very robust evidence that this is adding huge amount[s] of cost efficiency. I’d like to stress something very strongly: From my view, it’s not about the cost savings; it’s about doing the right thing. What we are doing to our patients is awful. When we do uncoordinated care, when we have somebody in their 80s seeing 76 different doctors and nobody is coordinating that, they are doing immense harm. We have the equivalent of a 747 crashing every day from the harm we do. It’s unspeakable violence to humanity. It's unspeakable violence, and that’s the reason why we are motivated to change this. It’s just unacceptable.

Jeremy Smerd is a reporter for Workforce Management.  To comment, e-mail editors@workforce.com.