HEALTH CARE: Medical Home Model Catching On

People hear "medical home" and they aren't exactly sure what it means. Judith Graham of the Chicago Tribune explains.

It's a new model of primary care that can address a lot of what drives us crazy in U.S. medicine  (at least those of us with doctors and insurance). There isn't yet precise agreement on what a medical home is, or who it should serve, but usually the idea is a way to improve primary care, with particular emphasis on prevention and control of chronic conditions such as asthma or diabetes.

So instead of long waits and rushed visits, Graham writes, imagine this:

The phone rings and it's the doctor's office reminding you that it's time for your flu shot and to have your cholesterol levels tested.

"Oh, and Mrs. Smith, I know you have diabetes," the nurse continues. "How is everything going? Do you need anything from us?"

A week later, there's an e-mail from your physician on your BlackBerry. "Mrs. Smith, I adjusted your medications at our last visit. If you're having any side effects, please call," he writes.

The medical home concept usually entails a team approach. A physician or physicians works with nurses, physicians' assistants and health coaches. The doctor directs the overall care, and takes the lead on the more complex or compelling conditions. (For other posts we've written on successful medical homes in a variety of settings, including some adapted by solo practitioners, see here, here, here, and here)

A pioneer in this field is Seattle-based Group Health Cooperative (part of the Health Care CEOs for Health Care Reform) Early data show that its medical homes have reduced emergency room visits by 29 percent and hospitalizations by 11 percent while improving quality of care, according to a September report in the American Journal of Managed Care.

Routine tests are arranged before an appointment, not after, so the doctor has the results when the patient comes in. Nurses follow up by phone when a patient goes to the ER or the hospital. Doctors make phone calls and email patients -- activities which can be very efficient for follow up and monitoring but which doctors in traditional care settings don't get paid for.

For medical homes to work we'll need to change how doctors are paid (which health reform would do, up to a point, and which private insurers are also starting) Electronic health records are also essential. People sometimes worry that medical homes will be like the HMOs of the 1990s -- and in some ways they will. But the HMO model easily became about restricting care because that's how the economic incentives worked. The medical home model, in contrast, has built-in rewards for quality of care. Medical homes thrive when and only when the patients thrive.