Every time JoAnna James took her husband, Lawrence, to the doctor, she left the hospital without understanding what was wrong with him.
“You ask them to break it down so you can understand what they are saying,” the 67-year-old woman says of doctors, “and they make you feel like there is something wrong with you.”
Frustrated, the couple signed up two years ago for an experimental program at the University of Chicago. Their new primary-care doctor explained Lawrence’s prostate cancer diagnosis and every procedure that followed until they understood each of them.
“She speaks your language,” JoAnna James says.
The Comprehensive Care Program, funded with a $6.1 million federal grant, is an example of a new model of care aimed at shifting doctors’ focus from treating symptoms to treating people.
When Lawrence James became too sick to leave the house, the program sent a doctor to the couple’s home. After he died last spring, the couple’s doctor alerted specialists treating JoAnna James in case her health deteriorated.
This individualized model of care, called “person-centered care” or “patient-centered care,” is based on the idea that costs can be reined in by preventing expensive emergency room visits. It’s starting to take hold among those caring for the sickest and oldest patients, though the fee-for-service model — in which doctors are paid for the services they provide regardless of the outcome — remains, by far, the norm in the United States.
“It’s hard to change what’s been embedded in concrete for decades,” says Robert Berenson, a fellow at the Urban Institute.
Experts say one hurdle is the wonky name, which makes people think it’s just a gimmick to cut services.
A poll of Americans 40 and older conducted by The Associated Press-NORC Center for Public Affairs Research reveals skepticism among those who haven’t tried this new kind of care. More than half of those receiving or providing care without having a single health-care manager — one aspect of person-centered care — didn’t think their care would improve much if they had one. More than three quarters of those who had one said it improved things a lot.
Dr. Marshall Chin, a professor of medicine and health-care ethics at the University of Chicago who focuses on health disparities, says there should be financial incentives for those who embrace the new model of care.
“The more that we say that patient-centered care is something we value and that it would be rewarded, the faster that it would happen,” says Chin.
The federal government is beginning to align payment with this kind of care. But critics including the American Health Care Association — which represents operators of facilities for the elderly and disabled nationwide — say proposed regulations to require additional training for staff in patient-centered care and on preventing hospitalizations and infections seek “too much, too soon and at too great cost.”
“Good quality of care comes with a cost, period,” says John Vrba, chief executive of Burgess Square Health Care & Rehabilitation Centre in Westmont.
At the west suburban center, person-centered care can involve some residents getting a cup of coffee as soon as they wake up, while others sleep late into the morning. Sometimes, an administrator takes a resident on trips downtown.
Neal Glein, the facility’s administrator, says the center runs a deficit of $36 a day for each of the 30 residents it has who are on Medicaid — about one-quarter of its residents. On top of that, the state’s Medicaid payments are usually six months to nine months late, he says, and there is no reimbursement for activities, such as outings, that help with residents’ mental well being.
“That’s where the struggle comes in,” Glein says.