The Medical Home: A model for the future
The concept of a “medical home” has been around for a long time. Quality and safety are hallmarks of the medical home and healthcare reform is placing greater emphasis on the model. But what exactly is a “medical home” and how does it affect the way you receive healthcare?
The American Academy of Pediatrics (AAP) introduced the medical home in 1967 as a way to enhance the care of children with special needs. The Future of Family Medicine Project expanded on the idea in 2004 when it called for every American to have a “personal medical home”. In this model, the traditional doctor’s office is the central point for patients to organize and coordinate their healthcare, based on their needs and priorities.
Dr. Kimberly Allen, pediatrician with Columbus Children’s Healthcare, says there is an advantage in patients having a medical home. “All of the patient’s information about their care is easily accessible,” says Dr. Allen. “If the patient sees one primary provider or clinic, they have established a relationship with that “home”. The relationship allows them to obtain the best care.”
Although there are things that occur during non-office hours, Dr. Allen says that it is to the patient’s benefit to try and wait to see their personal physician. But she also notes that when there is an emergency or the condition cannot be handled in the office because of the severity, patients need to seek medical attention immediately.
The primary care physician (PCP), which includes family practice physicians and pediatricians, are trained to provide first contact, continuous and comprehensive care. The PCP is responsible for providing all of the patient’s healthcare needs or taking responsibility for appropriately arranging care with other qualified professionals. This includes care for all stages of life: acute care, chronic care, preventive services and end of life care.
Dr. Kip Anderson of Columbus Family Practice notes that the term of “medical home” has evolved in recent years. “There is more to a medical home than just providing a PCP for each patient.” Dr. Anderson says. “The current standards as defined by organizations like the National Committee for Quality Assurance (NCQA), require physician offices to change their practices from being physician-centered to more patient-centered. This means providing greater access to care for the patient with extended hours, electronic communication, and patient portals to their health records.”
“It challenges physicians to do a better job of ensuring that patients are getting appropriate screening tests like mammograms and colonoscopies,” he continues, “as well as providing management of chronic diseases like diabetes.”
Studies show that those who not only have a regular source of care but continuous care with the same physician, over time leads to better health outcomes and lower costs.
Dr. Jeffrey Gotschall of Columbus Medical Center feels a medical home adds value by centralizing care and providing close oversight of treatment paths for efficacy, medication compliance, possible adverse effects or complications, and other medication management issues.
“Medical home encounters and close outpatient monitoring/follow-up provide more opportunity to identify issues and assure desired responses are in the proper direction to promote quality.” Dr. Gotschall continues, “It allows the physician to work on a patient’s behalf to control costs by avoiding unnecessary inpatient hospitalization and expensive diagnostic testing.”
In recent months, legislators, large employers, patient groups and organized medicine have begun supporting the idea of medical homes as the centerpiece of a primary-care based approach to healthcare reform.
“Despite what the politicians decide to do with healthcare reform,” says Dr. Gotschall, “the pressure to improve quality will never let up.”
Dr. Anderson says the medical home concept is tightly linked to a desire for payment reform. “There has been a steady decline in the number of medical students choosing to go into primary care and one of the leading reasons has been the widening gap in income between specialist and primary care.” he says, “If the trend continues, there will be a huge shortage of PCPs in the future.”
He also says the medical home projects, like the one in Lexington and Kearney, use the traditional physician fee for service payment, but also incorporate a monthly management fee paid to the physician by the insurer for each patient enrolled in the project. “The intent” he says, “is to compensate the physician for an increased amount of time in coordinating healthcare.”
The concept of a medical home centers on characteristics that drew many family physicians and pediatricians to the specialty: the opportunity to provide patient-centered, coordinated, and comprehensive care to patients of all ages over time in the context of their family and their community.