Pulling back the curtain on the medical home

Those who've experienced the medical home model describe it as modernized Marcus Welby care. Physicians work closely with a more manageable number of patients and conduct unrushed, same-day visits, sometimes even at patients' homes. But rather than going it alone, medical home docs have the support of powerful technology systems and coordinated medical teams to help keep patients healthy and out of the hospital.

And with studies such as those featured in the May issue of Health Affairs revealing dramatic cost savings and quality improvements, some say the medical home may even represent the only known cure to the desperately ailing U.S. primary care system.

"Nationally, the patient-centered medical home is emerging as a key way to improve health care and control costs," said Robert J. Reid, MD, PhD, associate medical director for preventive care at Seattle-based Group Health Cooperative, which reported that for every dollar it invested in the medical home, it recouped $1.50.

So, is there anything bad to say about the 'dream care' discovered by Reid and other physicians such as Larry Halverson, MD, of Cox Family Medical Care Center, the first NCQA-certified Level 3 Patient Centered Medical Home in Missouri, or Joseph Mambu, MD, the only Pennsylvanian physician accepted into the TransforMED Demonstration Project run by the American Academy of Family Physicians?

One con is that despite all of its promise to reinvent primary care, the medical home will in many areas remain dark without enough physicians, particularly geriatricians, to care for aging Baby Boomers and those newly insured under health reform. According to the Association of American Medical Colleges, the United States will face a shortage of 46,000 primary-care physicians by the year 2025 if more drastic changes don't take place.

"We believe very strongly that primary care is currently in a very precarious situation," Bill Leinweber, executive vice president and CEO of the American Academy of Physician Assistants, told American Medical News. "Clearly, the medical home is a key issue. But who's going to run them? There simply aren't adequate work force resources right now."

Purchasing and implementing the electronic medical records systems crucial to make the medical home work pose significant challenges as well. "There's an investment in time, and change and angst, and change fatigue, and it goes on for months and months, and sometimes you don't see any progress," Mambu, who spent $100,000 on his EMR, told the Philadelphia Inquirer last Monday. "And you're doing this as a leap of faith right now. Will payment evolve? Will there be reform to fund this kind of development?"

Mambu has helped offset these costs by becoming a certified medical home joining his region's "learning collaborative" after finishing with TransforMED in 2008, which yields him extra incentives from insurers in exchange for tracking data on diabetes care. And while such healthcare collaboratives seem to be leading to performance improvement throughout the country, Mambu says that his plans to network with 15 neighboring medical homes could eventually lead to direct contracts with big employers and government to give medical care that will be cheaper and focus more on prevention, the newspaper reports.

And with the new health law providing billions of dollars and great discretion to the secretary of health and human services to promote the model around the country, Paul Grundy, director of healthcare transformation at IBM, a leader of the TransforMED project, says that the nation has already reached the tipping point in which the medical home will represent the prevailing model of medical care.

Indeed, pilot projects seeking to promote and fine-tune the medical home model abound throughout the country. In states and countries that have fully implemented the medical home concept, such as Iowa, Michigan and Denmark, there have been 40 to 50 percent reductions in hospitalizations, with cost reductions of 5 to 15 percent, Grundy told the Providence Business News for an article about health reform in Rhode Island. "In Denmark, over the last few decades, the number of hospitals has dropped from 155 to 21 today, according to Grundy. "That is the kind of phenomenon that could happen [in Rhode Island]," he said.

But paying for the programs remains the big question. Despite unanimous Senate approval of a medical-home bill in Ohio, for example, no specific sources of funding for the projects were identified. Instead, the advisory group is charged with finding grants, federal funds or private donations to pay for the program, MedCity News reports.

To learn more:
- read this piece in American Medical News
- check out this article in the Philadelphia Inquirer
- see this story on News-Leader.com
- read about Ohio's medical-home progress in MedCity News
- learn about the Rhode Island medical home pilot in the Providence Business News

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