Patient -Centered Care and the Medical Home

In my last blog post, I talked about Patient-Centered Care, how the concept evolved, and where we are today. A medical home is a model of care delivery that enables patient-centered care. It is a health setting where a specific health care provider /physician leads a team of professionals who take care of you. Does this sound a lot like the old fashioned family doctor that your parents saw 50 years ago? -- a doctor who really knew you as a person and followed you from birth until you either died or left the practice only because you relocated?
The 21st century twist is that in today’s medical home you, the patient, are a member of the care team, and technology, including email, the Internet, digital health records, smart phones, and secure patient portals, helps facilitate your care and insure personalized care coordination and continuity. The medical home concept also includes a proviso that you have more access to your care team including open scheduling, expanded hours and new options for communicating with your team such as e-visits.

Three trends are building the current momentum around the medical home: (1.) a growing shortage of primary care physicians, thus the need for a team to pick up some of the responsibilities (2.) the increasing prevalence of chronic disease among the population that needs constant managing and monitoring, also enabled by the support of a team of providers, and (3.) the availability of health information technology (HIT) .

The escalation of health costs and growing numbers of individuals with chronic diseases, validates the medical home model that incorporates primary care physicians who lead multidisciplinary teams that include support staff such as nurse practitioners, physician assistants, pharmacists, nurses, social workers, therapists, and other care extenders. Underlying this assumption is the premise that HIT systems support coordination and continuity of patient care. Government initiatives, including incentives for physicians who adopt of electronic health records, as well as a cultural change in physicians’ attitudes toward implementation of health IT such as e-prescribing, web resources, smart phones and smart pads to communicate with patients and electronically monitor chronic conditions, will help the medical home concept gain traction.

Several pilot projects with the patient-centered medical home (PCMH) indicate the success of this approach. All of them employ care teams to coordinate and manage care with primary care physicians leading the teams.They also use health information technology to standardize work flow and to enhance the patient/physician relationship.

One successful pilot was held at Group health in Puget Sound, Seattle Washington. Group Health provides health care insurance and comprehensive care to approximately half a million residents in the northwestern United States, including twenty primary care clinics where patients choose a primary care physician to guide and coordinate their care. These physicians (81.6% family physicians, 3.5% general internists, and 14.9% pediatricians) care for an average of 2300 patients and work in multidisciplinary teams. Between 2002 and 2006, Group Health implemented a series of reforms to improve efficiency and access including same-day appointment scheduling, direct access to some specialists, primary care redesign to enhance care efficiency, and an electronic medical record with a patient Web portal to enable patient e-mail, online medication refills, and record review. The reforms succeeded in improving patient access. Group Health then developed a pilot of a patient -centered medical home (PCMH) redesign in a single metropolitan Seattle clinic serving 9200 adult patients with the goal of spreading lessons learned to other clinics. Structured around a thorough electronic medical record system, frequent patient communication, and regular medical team collaboration, this approach at Group Health improved patient satisfaction and reduced clinician burnout rates and reduced health care costs. With their PCMH, patients had 29 percent fewer emergency visits and 6 percent fewer hospitalizations, resulting in a net savings of $10 per patient per month. For every dollar Group Health invested, mostly to boost staffing, it recouped $1.50.This evaluation prompted Group Health to spread the medical home to all 26 of its medical centers, which it finished doing in January, 2010. http://www.grouphealthresearch.org/news-and-events/newsrel/2010/100504.html

This is just one example of how an implementation of the PCMH results in successful patient engagement in care, coupled with improved working conditions for the physicians and significant cost savings. There is much promise that the PCMH could elevate the quality of health care for everyone and might just be the answer to many of our health care system woes.