Managed Healthcare Executive recently published the attached article regarding key challenges facing health plans in 2009. The primary challenge that health plans will likely facing according to a survey of health plan executives is competing in the marketplace.

I found this article interesting because the strategies that the identified health plans are using to differentiate and improve their competitive position in the marketplace vary dramatically. Particularly interesting to me was CDPHP’s objective of operating off the framework of the medical home model, which originated around coordinated care efforts for children. However, in the past few years it has broadened to include prevention and improving coordinated care. At the center of this framework is the primary care physician acting as the quarterback for better-coordinated care. While in theory it sounds logical, there are some critical challenges facing this model including:
• A shortage of primary care physicians
• Inequitable reimbursement versus specialty physicians
• Technology issues around data exchange and in some instances a total lack of technology at all

Bruce Nash, MD, chief medical officer for CDPHP believes that “A medical home model will promote primary care as a specialty, develop a new compensation system for PCPs, increase access to PCPs, enhance chronic condition care, decrease redundancy of care and increase value to both patients and providers…You can’t have payment reform without practice reform”

While I agree with many of his points, I wonder if he is over simplifying the model. The challenges of increasing capacity and access are very real given the shortage of PCPs in this country. Furthermore, chronic condition care of an aging population has already created backlogs and requires far more time than most physicians have available.

However, out of all of the strategies mentioned, I think that CDPHP is intriguing because it places prevention and active disease management at the front and center of a new way for health plans to engage patients in preventive behaviors.