Medical Homes

It’s not a new concept. In fact, I would be willing to bet that if you ask older individuals and those living in rural areas most of them would tell you they have a family physician or primary care physician. Believe it or not, patients actually call and make appointments with one physician for every medical problem they encounter. That physician then treats or refers. Easy concept. The family physician or primary care provider serves as a gatekeeper to the rest of the system. Difficult today for a variety of reasons.

This article on the American Academy of Family Physicians website says the medical home “is both old-fashioned and thoroughly modern – a blend of the personalized, comprehensive care that family physicians have been offering for decades and coordinated care that capitalizes on new technology and helps patients make sense of the increasingly complex health care system.”

Medical homes are gaining traction in the here-and-now. And for very good reason. When you read this editorial by Dr. Benjamin Brewer at the Wall Street Journal I think you will see why.

Recently, the Illinois Medicaid program decided that nearly every recipient of public aid needed something called a “medical home.” The idea is to provide an accessible, lower-cost point of entry into the health-care system than a hospital emergency room. A practice that agrees to provide the home makes a commitment to take an active, integrated approach to coordinating a patient’s medical care.

The American Academy of Pediatrics “describes the medical home as a model of delivering primary care that is accessible, continuous, comprehensive, family-centered, coordinated, compassionate, and culturally effective care.” Their website can give you a comprehensive rundown of medical homes.

Dr. Brewer goes on:

Patients and their doctors have 24-hour access to the information or advice from us by phone or email. We provide prenatal care, delivery services, child and adult care in the office and the hospital. We measure our quality quarterly by looking at some key indicators. We don’t avoid patients of any age or gender or those with chronic, pre-existing conditions. We maintain a list of available specialists and coordinate referrals and follow-up.

All for around $2 per patient per month in addition to office visit fees for services. It seems impossible in our $2 trillion health system. But Dr. Brewer says he is doing it. The care that was once provided free is now being reimbursed.

What’s missing in the debate over our nation’s health-care crisis is that primary care is cheap. Cheaper than your cellphone bill. Cheaper than a tank of gas. Cheaper than dinner and a movie. It’s so cheap the average person doesn’t value it properly. I could have covered my salary for 2007 and the costs of all my staff and overhead for less than $20 per patient per month, including maternity and hospital care.

I’ve blogged about private industry making change in health care on this blog before and have referred to this article as well, but it is worth noting again–a group of employers is partnering with Bridges to Excellence to pay doctors for creating medical homes for patients. “The initiative is the latest and perhaps most far-reaching effort by Bridges to Excellence, a program backed by big employers and health plans and a big player in the movement to provide physicians with financial incentives for taking better care of patients.”

But considering how often we introduce new ways to deliver care and then how quickly those innovations disappear the implementation and effectiveness of the medical home is dependent upon a variety of factors.  According to the AAFP article, “Whether the concept takes root may depend on two key issues: whether payers can be convinced of the value of medical homes (and the need to pay more for them) and whether physicians can deliver what the medical home promises.”

The concept is not new. But it seems to have been forgotten. If it can help the uninsured, stymie health care costs, and make us healthier, it should be obvious that we need to explore this option further. Any thoughts?

Some more reading here that debates some pros and cons.

is working to implement the medical home concept through its mission “The mission of TransforMED is to lead and empower medical practices in implementing the new model of patient-centered care — thereby improving health care for their patients, as well as the success of their practices.”

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