Have you heard about the “medical home” model of care, currently developing in Illinois and making its way into other states?
As described by Chicago Tribune reporter, Judith Graham, this new model of care sounds almost too good to be true. Graham describes it as “primary care on steroids, devoted to prevention and to helping people with chronic conditions such as asthma or arthritis manage their illness.”
In the “medical home” model, you might receive phone call reminders from your doctor’s office, checking to see if you’ve had your flu shot or your cholesterol levels tested. A nurse might ask how things are going and if you have any needs, given your diabetes. Maybe an e-mail from your doctor will pop up in your inbox, asking if you’ve experienced any side effects from the adjustment in meds made at your last visit. When the model is operating in its ideal form, writes Graham, “a doctor oversees a team of nurses, physicians’ assistants and health coaches who ensure patients get needed care, support and education. That frees the doctor to focus on compelling medical issues.”
Illinois’ largest insurer has launched a pilot program of the medical home model. In September, Medicare announced a similar proposal. Graham also asserts that current health reform plans contain changes designed to encourage the use of medical homes.
Groups that have been successful have seen reduced ER visits and hospitalizations, along with improved quality of care. Because doctors are assigned to fewer patients (in one model, physicians were assigned 1,800 patients instead of 2,400), they can spend more time with those who need it most.
So what are the possible barriers, you ask? One of the biggest hurdles is that a fundamental change must take place in the way doctors are paid; many physicians have thus been resistant to the changes incurred by the model. Also, many doctors are not used to working in teams or being held accountable for results, writes Graham. Finally, many doctor’s offices still do not have electronic records, which makes the follow-up and tracking employed by the medical home model quite difficult. If these obstacles can be overcome, the medical home model, with its emphasis on prevention, care coordination, and management of chronic conditions, may well become the next great frontier in health care.
Prevention is a term not often heard in standard medical practices. Getting a phone call from the doctor reminding us to get a flu shot or asking how we’re faring with our chronic condition(s) may seem strange. It’s likely that most of us visit the doctor only if we are really, really sick, and even then, some people prefer to tough it out with home remedies and over-the-counter meds instead of paying for a 30-minute wait in the doctor’s office only to find out that it’s nothing more than a sinus infection or some other easily treatable illness. (To be fair, I know that there are times when seeing the doctor is the best option, and on some of those occasions, you may not have to wait very long to see your physician.) But let’s be realistic – doctors may see hundreds of patients a day and may not have the luxury to spend enough time with each one discussing medical history and possible prevention techniques. Maybe the medical home model is a step in the right direction. Time (and perhaps the outcome of the current health reform debate) will tell.
SFL followers, what are your thoughts on the medical home model?