Nursing at center of medical home concept

That's the conclusion I draw after sleeping on the notes of an interview I held yesterday with Sam Muppalla, chief operating officer for Portico Systems, which is helping drive the concept.

A big part of the appeal is that nurses do more, while doctors control the process and those who pay the bills save money. The chronically ill also get better care, because they have what all clients want, accountability.

"We work with plans to scale the medical home program without placing an undue burden on providers, allowing providers and nurses to participate in collaborative care."

In English, Portico is working to help the coaching concept make financial sense, using technology to tie insurance carriers, doctors, nurses and patients together.

"A nurse can be a head coach for care of the patient, but they need intelligence, they need tools for secure messaging, they need EMRs in place," Muppalla explained. Portico seeks profits by providing this glue.

A lot of glue is needed. Portico needs sophisticated links with carrier payment systems so it can reduce paperwork and assure payment. It needs EHRs to be shared by doctors and nurses, with secured messaging, so docs retain control while nurses do the heavy lifting.

And it needs to deal with evidence-based best practices, both to guide nurses and make it all affordable.

This is an awful lot of technology. Portico, which began 10 years ago as a provider management outfit, helping carriers gain greater control over hospital expenses, is not dictating anyone's technology choices, except its own.

"We have an end to end platform, but we can also interoperate with whatever they have. There's a Web based alternative, or we can interoperate with another vendor." The flexibility helps give Portico value to all sides in the transaction.

For those who see EMRs as a bogeyman, or fear outside control of doctor decisions, a talk with Portico is a wake-up call.

What is the difference between an insurer running an evidence-based system, in order to improve outcomes and control costs, and creating such a system every patient and professional can use?

Government.

Will fighting evidence-based healthcare, or comparative effectiveness, really result in doctors being able to do what they want and ignore the needs of those paying the bills?

No.

The industry does not want this trend slowed. This trend promises both better care and lower costs. That's the goal of whoever pays the bills, whether that be government, an insurance carrier, or a patient's family.

Evidence based healthcare is a trend whose time has come. Seeking to stop it, on whatever pretext, is a losing proposition.