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Medical Homes Offer Promise for Improved Health Care

The fragmentation of the medical system is apparent to anyone with a recent experience of serious injury or illness. Coordination of care becomes the responsibility of the patient and his or her family because no one else is doing it.

One daughter tells her story about this lack of coordination: “At 90, doctors diagnosed my dad with two slipped discs, an extremely painful condition, but due to his age, they were unwilling to perform surgery. In constant severe pain, he received treatment through urgent care, an emergency room, a hospital, and the rehabilitative floors of three nursing homes.

“During a six-month period, he had a different doctor attending him every time he went to an appointment, entered the hospital or received rehabilitation, all of them from one large clinic. None of them talked to each other, or at least it appeared that way to my mother and me. At one nursing home, the staff was not even aware that he had two slipped discs. To find someone to integrate services, we contacted a block nurse program, which worked with us until he entered an excellent nursing home by way of the third rehabilitative stay there.

According to the Robert Graham Center,  “Health care in the U.S. has moved steadily toward reduction—people receiving care for specific diseases and organs and increasingly absent any consideration of their quality of life and their priorities or of potential interaction of treatments.

We all are looking for ways to make health care more accessible, more affordable and more effective. The Medical Home model is one approach that is delivering those outcomes while potentially eliminating the fragmentation of services and helping people live healthier lives. To make medical homes work on a widespread basis, however, requires significant changes in how we deliver and pay for health care services

What is the Medical Home model

An essential element of the Medical Home model is a primary care physician who oversees all aspects of an individual’s care, integrating services to assure his or her physical, mental and social well-being. The model treats the individual holistically, choosing clinical priorities based on the individual’s medical needs and on his or her personal values and providing services across multiple settings, including the person’s home.

Each person has an ongoing, personal relationship with this primary care physician. When needed, the physician brings together a care team of specialists or other service providers and coordinates care to ensure that it is patient-centered and integrated.

Why is it better?

The current design of the health care system encourages physicians to see more patients in smaller amounts of time, emphasizes paperwork, and requires physicians to juggle the financial complexities of public and private insurance companies. Often individuals don’t receive appropriate care due to the lack of coordination among service providers.
The focus on coordinated care makes the Medical Home model different. In addition, individuals receive enhanced access to primary care through open scheduling, expanded hours and better options to communicate with physicians and staff.
Some evidence exists that the Medical Home model improves the quality and coordination of care, controls costs, improves patients’ satisfaction and makes primary care an appealing specialty again for doctors. In fact, the Geisinger Health System in Pennsylvania decided after  two years of experimenting with the model to continue to use it. The practice reduced acute hospital admissions by 20%, decreased readmissions by 40% and cut costs by 7%, all while improving patients’ health.

What needs to change?

The current payment system has caused a major change within the medical profession. Doctors now are reimbursed for how much they do, for how many tests or procedures they perform rather than how effective the care is. Medicare currently reimburses face-to-face visits and pays little to nothing for coordinating care.

By 2011, the first of the 76-million baby boomers will be eligible for Medicare. Older adults tend to have more chronic conditions and to interact with doctors more regularly. Estimates predict that the U.S. will not have enough physicians to meet the needs and demands of an aging population. Currently, older adults are already experiencing difficulty in finding a primary care doctor. By 2020, the system will be short 200,000 physicians.

To counter this trend, provide needed doctors, and take advantage of the benefits of the Medical Home model, the medical system needs payment reform to provide coverage for quality, continuing and coordinated care.

For more information, see:
The Patient Centered Medical Home
Closing the Divide: How Medical Homes Promote Equity in Health Care: Results from the Commonwealth Fund 2006 Health Care Quality Survey

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