I don't want to hear that!

Kevlar vests must have been invented for people like Al Lewis.  He fearlessly goes where few dare to tread, attacking the fads and shibboleths that are propounded as truth in health care policy debates.  A sign of his success is that people try not to debate him.  They know they can't win, so they hope that ignoring him will allow the myths on which they are operating to persist.

His latest column on the The Health Care Blog is illustrative.  Here are some excerpts:

It’s not quite time to publish the obituary for by far the most extensive patient-centered medical home (PCMH) network in the country, Community Care of North Carolina (CCNC) but it’s certainly time to spellcheck it.

This wasn’t just any old medical home – it was the “poster child” for the PCMH movement, even making it onto NPR.

Meanwhile, the overall North Carolina Medicaid budgets were frequently exceeded, by considerable margins – $1.4-billion in the last three years alone. But few people made the connection between that unanticipated extra spending and CCNC, because CCNC hired gold-plated consultants — first  Mercer and later Milliman – to demonstrate dramatic savings from the PCMH itself.

Fortunately for Mercer, Milliman is bearing most of the scrutiny now, being the more recent of the two studies.  Their results were also obviously impossible, showing up to $250,000,000 in annual admissions savings despite the state spending only $114,000,000 in the year prior to the study and despite the fact that there was no decline in admissions.

The subsequent CCNC and Milliman defense strategy, invented by the tobacco industry and perfected by the fossil fuel interests, has been to “sow doubt” and emphasize tangents so that journalists need to write “he said-she said” stories and follow up on irrelevancies.

Meanwhile, CCNC and Milliman haven’t actually answered the questions that get to the heart of whether they misled people for so long on purpose or simply out of ignorance.  

This is not just about North Carolina.  As noted above, PCMH adherents embraced CCNC on its way up to the point where PCMH and CCNC are joined at the hip.  So what does the PCMH movement do about these folks on the way down? In Medicaid – the category where improved access should make the greatest difference — adoption has slowed to a crawl even with the 9-to-1 [federal] match.  Further, one of the pillars of the PCMH is prevention, which may not save money. At the very least, PCMH adherents, to quote the immortal words of the great philosopher Ricky Ricardo, will have a lot of ‘splaining to do.