Home, Sweet Medical Home

If you have been following health care issues, there is a high probability that you have already run across the concept of a "medical home." It's a concept that has been bandied around frequently and and as often as not seems to be surrounded by hype. Alice Dembner at The Boston Globe takes a close look at the concept of medical homes in a recent article. The prognosis seems quite positive:

The future of primary care medicine is taking shape in Somerville's Union Square.

Doctors quickly answer patients' questions by e-mail and phone.

Visits are available from early morning into the evening and Saturdays.

The medical team tracks patients' needs so closely that they know when a diabetic misses a critical blood test or an asthmatic needs a new inhaler.

Across the nation, patients are so frustrated by lack of access to their doctors that they are going to drug-store clinics for basic care. And primary care doctors are so harried that they are abandoning their practices in droves.

The "medical home" being created at Union Square Family Health and at many doctors' offices across the nation is an attempt to provide an alternative. Such a doctor or nurse-practitioner-led team practice is designed to offer patients care when and where they want it and to give the team the money, the tools, and the time to do more than triage.

While this may sound too good to be true, research indicates that this could well be the wave of the future. Removing the perverse incentives or per visit billing, providing the added efficiency of electronic medical records, and resurrecting the "personal touch," so often bemoaned due to its lack, the medical home seems to solve a variety of the issues plaguing medical delivery in the modern age.

At the Union Square office, doctors offer one-stop shopping for physical and mental care, provide group as well as individual visits, and recently began encouraging patients to e-mail their doctors and view portions of their computerized medical record through a secure website.

Cidalia Moura, a 57-year-old Somerville factory worker, learned about the computer access from her doctor last month. The convenience of renewing prescriptions online is very appealing, she said, as are the evening hours. But what matters most, she said, is the time with her doctor and nurse, and feeling truly cared for.

The stereotype of Marcus Welby style doctor is considered outdated, a relic which has gone out of style along with house calls. That personal relationship with one's doctor is invoked with a wistful nostalgia by many people who feel as though they are on a carousel spinning from one specialist provider to another, none of whom they experience a personal connection with.

Not only does centralizing care help recreate that sort of connection, but it may also be able to amend the payment scheme which created the disconnect in the first place.

At Massachusetts General Hospital, Dr. Allan Goroll is raising private money to test a medical home model where doctors are paid per patient, instead of per visit, to encourage comprehensive care and ease the pressure on physicians.

"Doctors now are on a hamster treadmill," said Goroll, an internist who cofounded a primary care training program at Mass. General decades ago. "They have to maximize visits to keep the lights on in a practice. There isn't much pay for thinking, talking to patients, and coordinating, just for doing things."

"Patients have the sense that the doctor is rushed, not available. Physicians feel poorly and patients are unhappy. It's a downward spiral." [...]

For a total cost to the healthcare system of just $500 to $800 per patient each year, he said, doctors could run an office that included a nurse practitioner, nurse, medical assistant, receptionist and part-time social worker and nutritionist. Patients would not have to pay extra, he said. To discourage the team from withholding care, a portion of the fee would be paid only if quality goals were met.

The full article is well worth the read. It contains a number of short case studies as well as data on several different trial runs of the medical home concept being piloted across the U. S. It also brings up and addresses some of the issues with such a transition, such as cost of embracing electronic medical records, etc.

I believe this could be the wave of the future, what do you think?

SOURCE: "A more welcoming model for care" 05/19/08
photo courtesy of Michael L. used under its Creative Commmons license