A new coalition of employers, medical societies, and healthcare organizations is pushing for healthcare reform that emphasizes the American Academy of Family Physicians' medical home model. Spearheaded by IBM, the coalition stresses the importance of EHRs, patient portals, and community health information exchanges. But its key goal is to change the way primary-care physicians are reimbursed so that they can provide better care.

Of course, the two elements are connected: Many physicians feel they're being asked to invest a lot of money in EHRs without being reimbursed at a higher rate so that payers can save money. Dr. Paul Grundy, IBM's director of healthcare technology and strategic initiatives, says he can appreciate that point of view. "We need to look more holistically at the total cost of healthcare and where you focus resources," says Grundy, who was trained as a preventive-medicine specialist. "How do we, as buyers, pay the doctors more equitably upfront for disease management at the point of care and care coordination and better access? We believe that if you pay for those things, in the long run it probably won't cost us any more money. It's more about value than cost."

IBM, which spends $2 billion a year on health care for its own employees, has a direct stake in lowering health costs. But Grundy doesn't deny that the promotion of health information exchanges is also part of IBM's business strategy. In the recent pilot of the National Health Information Network, IBM was one of four consortia that tested an approach to exchanging patient data between different regions (in its case, east and west North Carolina and the mid-Hudson region of New York.) Also, IBM has built a national information network for Denmark, and it would like to create the same kind of system here, says Grundy.

The Patient-Centered Primary Care Collaborative, as the coalition is known, encompasses companies that employ more than 50 million Americans. Besides IBM, the coalition includes Exelon, GM, the National Business Group on Health, Walgreen's, and Wyeth. Among the medical societies represented are the AAFP, the American Academy of Pediatrics, the American College of Physicians, and the American Osteopathic Association. The National Association of Community Health Centers also belongs to the coalition.