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Observers hope Merck's embracement of health reform effort leads to wider adoption

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While Merck & Co. isn't the first corporation to promote the benefits of patient-centered medical homes on a national scale, an early implementer of the health care model said the pharmaceutical firm's efforts to internalize the message will encourage more primary-care doctors in New Jersey to take the leap in transforming their practices.

"Even with the known benefits of reducing costs and improving care, primary-care practices have been reluctant to invest in this model because of their economic situations," said Dr. Alfred F. Tallia, chair of the Department of Family Medicine and Community Health at UMDNJ-Robert Wood Johnson Medical School. "The fact that a very large employer in this state — regardless of it being in a health-related industry — is promoting this and telling its employees, 'Look for these kinds of practices for your next doctor's visit,' will motivate more practices to adopt this model."

To externally promote the health care model, Merck released an educational video providing an overview of the National Committee for Quality Assurance standards and processes for primary-care doctors to transform their practices into federally recognized patient-centered medical homes.

Merck collaborated with NCQA in support of the PCMH model "because it supports one of Merck's key objectives — helping health care professionals to improve patient health outcomes cost effectively," said Dr. Sethu Reddy, vice president of U.S. medical affairs for Merck, in an e-mail. "We are hopeful this simple resource will be used by many primary-care practices to help understand the benefits of becoming a patient-centered medical home, and the steps to earn PCMH recognition."

Tallia said the patient-centered medical home model — which requires primary-care physicians and nurses to improve a population's access to care and coordinate ways to manage patients' chronic conditions over time — also can benefit pharmaceutical firms like Merck on the level of drug discovery and development.

"One of the big issues around health care reform is appropriate use of medications, so if you know the effective use of new drugs, it can reduce costs and improve quality across the whole spectrum, by avoiding unnecessary hospitalizations and better managing diseases," Tallia said. "It sends a message to the other pharmaceutical companies that this is something worthy of consideration. It shows the agenda in health care and pharmaceuticals is finally moving from not only a discussion about costs, but also quality."

David Finegold, senior vice president for lifelong learning and strategic growth at Rutgers University, said Merck's participation is part of a "broader trend across industries from being product-focused to service-focused."

"With the components of patient-centered medical homes, like electronic medical records, pharmaceutical companies can build better information of who their drugs are working for," Finegold said. "The focus is on how they can do things earlier to prevent and manage disease, rather than focusing on end-of-life care, so Merck is reaching into that to see over time what drugs produce the best health care outcomes."

Since a significant component of a PCMH model is a change in the traditional payment relationship between primary-care providers and insurers — to pay doctors based on the quality of long-term care, rather than the quantity of procedures — Tallia said Merck's marketing efforts will encourage other large employers in the state to "communicate to their insurers that it's important and to get them on board" in implementing the new payment model, which only a limited number in the state are doing so far.

"The message Merck sends is this is no longer a concept, but rather something in the operational phase," Tallia said. "A lot of insurers are starting to move out of the pilot phase, because companies know it works and it's good for their employees. The fact that you've got a major Fortune 500 company like Merck seeing this as valuable in terms of their strategy as an employer really does a lot for this industry."

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