Bringing Healthcare Home: The Medical Home Model
You hear whispers of it on the wind, legends of time where one person saw one doctor, who knew all of their past ailments, and truly cared about their health and well being. This standard has seemed to have fallen by the wayside in the recent years, among all the chaos and hubbub of the current United States healthcare system. Doctors now get paid per patient they see per day, so crammed waiting rooms, curt visits and impersonal service have become the norm, and we have gotten so used to it that we haven’t even considered an alternate way of doing things. But take of your goggles of disbelief, because a more personal, cozy model of health care is being buzzed about.
What is the Medical Home Model?
Three years ago, the healthcare guru’s over at IBM started looking at what they were doing to improve the quality of life for their employees and realizing they were overlooking a crucial component: healthcare. After realizing this crucial change that needed to be addressed, the director of healthcare transformation at IBM, Dr. Paul Grundy, helped found the Patient-Centered Primary Care Collaborative (PCPCC). This coalition of large employers, consumer organizations and medical providers developed the Medical Home model, and its combination of old school patient care combined with the latest in medical communication technology makes this unique and optimistic proposal for healthcare. Under the Medical Home proposition, one doctor would act as a coach for the team of specialists treating one patient, including things like preventative, holistic and wellness needs. More time is spent with the patients in person than you are probably getting from your doctor now, and the doctor is accessible on the phone and via e-mail in addition to extended office hours and coordination of care across the entire medical team.
Advanced Technology and Medical Care
The sharing of a patient’s health information via an EHR, or electronic health record, is an integral part of how the Medical Home model works. An EHR can help to reduce errors, eliminate duplicate tests, highlight drug interactions, improve overall quality of care and reduce costs. This interweb of information can allow a patient to access a web portal to schedule appointments and check their lab results, patient registries and e-prescriptions. With the click of a mouse, information about a patient’s health can be shared across a network of healthcare providers, and patients can always stay in the know about their treatment, doctor recommendations and medications by hopping online or picking up the phone. Instead of wasting precious free time that most of us don’t have, you would be able to utilize the tools readily available to you in the form of your phone and computer to stay in touch with your physician. Doctors would get extra money for being available for the patients in odd hours, and offices can get a little bit more money by implementing the technological changes necessary to upgrade the office. Phone and e-mail consultations would be reimbursed.
Simply a Fantasy or Possible Reality?
The Medical Home model sounds just about as close to perfect as we can get in the realm of healthcare today. You would get more personal, face-to-face time with your physician, they would be highly accessible to you, you would have insight into how your health information is being shared and it would all be done using some of the best technological tools we have available today. If you are any type of a cynic, this sounds way too good to be true. Is it? Happily not, as there are early results showing that the model does work, and actually cuts cost for health care providers. For example, statistics from a 2008 report by Health Affairs shows:
- The Geisinger Health System in Pennsylvania reports cutting costs by 7% using the Medical Home model for 80,000 visits.
- A Medicaid experiment in North Carolina saved the Government $162 million in 2006, 11% less than the state would have paid under the old form of reimbursement.
As you can no doubt see, early studies are showing that the plan can and does work? But what are the roadblocks faced in implementing this around the country? Deployment is a huge issue. Fewer and fewer medical school students are choosing family practice as their specialty, leaving fewer doctors to give the great personal care to be highlighted in the Medical Home Model. This really isn’t too surprising, considering that family practitioners make about 1/4 of what specialists make in a year. Not only that, but it would take a full two to five years to fully convert to using this system, and some practices might not want to wait that long to see the changes implemented. This type of change wouldn’t just mean an updating of a practice’s technology, it would also be a complete revamping of the way things have been done, including staff training, knowledge, skills and attitude about the new model. For older offices set in their ways (think the Grandpas and Grandmas of general practitioners), this transition may be met with a lot of resistance.
As the country moves into a new era of administration and our health insurance and care system is facing changes, I can be hopeful that models like this will be among them. Based on personal experience, I believe that my old health insurance provider back in California (who shall remain nameless to protect their integrity) has started operating on a similar model. My doctor would input information into the computer after we were done talking, and could send my prescription down to the pharmacy with the greatest of ease. Where I live now in the Midwest, I am seeing trends like this in my health care now. While I didn’t feel like I was getting the most attentive of care from my personal doctor, I felt that the nurse who took down all my information into what looked like a little PDA device was very helpful. I can’t manage my health information online, but I do appreciate the ease of which my information was taken down and stored. Slowly but surely, it is my hope that we continue to crawl out of the healthcare dark ages and into the time of making it feel like home again.
Tags: Add new tag, electronic health record, health insurance coverage, healthcare, high-tech, home medical care, in home care, medical home model
March 1st, 2009 at 2:29 pm
The medical home model may indeed be a dream. In this day of uninsured persons going to urgent care centers, retail care centers, EDs, etc. the medical home may be out of touch.
What may be a solution is the medical record home - a national medical record that each of the above mentioned health care venues has access to. The patient may never have a medical home but he or she has ONE record that is managed by all of his care givers.