The medical home: what health care needs now

Claire McCarthy MD

You may have heard the term “medical home”—it’s been bandied about recently as something we all should have. No, it’s not a nursing home. Nor is it a house well-stocked with Band Aids and Tylenol, or one where doctors live.

The American Academy of Pediatrics defines medical home as “a model of care that is accessible, family-centered, continuous, comprehensive, coordinated, compassionate, and culturally effective.”

Well, that sounds exceedingly lovely. Of course we’d all want that. But still, what does it really mean?

Let’s get more concrete. You have a medical home if:

  • You can get the care you need when you need it
  • You can easily get the health advice or information you need
  • You can easily get the specialty care, services, or equipment you need
  • Your health care provider follows up with you about that specialty care, services, or equipment
  • Your health care provider spends what you consider enough time with you, and explains things so that you can understand
  • You have a consistent health care team that knows you, as opposed to seeing lots of different people in the practice
  • The practice understands and meets your cultural and language needs—like by getting an interpreter if you need one, or by taking the time to understand what your religion allows you to eat before giving you dietary recommendations.

It turns out that this kind of medical care not only makes people happier (who wouldn’t be happy with it?) but healthier. They get sick less, and end up in the emergency room less. It’s particularly good for people who have medical problems and see a lot of specialists, but a recent study from Boston University showed that kids who had medical homes were more likely to get—and follow—good general health advice. Compared to kids who didn’t have a medical home they watched less TV, were more likely to wear bike helmets, and were more likely to have their parents read to them every day.

So the medical home model not only cuts health care costs (by keeping people healthier and out of emergency rooms) but can have real public health benefits too (which leads to even more health care savings in the future).

So…why don’t all practices work this way?  Really good question.

Some practices are just stuck in their ways and don’t want to change. But for most practices, it’s not will but money that gets in the way. To make this model work, you need good technology—a good electronic medical record, good phone and information systems—which can be expensive. Even more, you need extra nurses and social workers and secretaries and interpreters to do the extra tasks that make it really work, and staff is expensive—especially when most of those extra tasks aren’t covered by insurance.

To further underline how much this is about money, the Boston University study showed that the kids who were most likely to have a medical home were white, spoke English, lived in a 2-parent home with educated parents, had health insurance and a had family income that was at least four times the federal poverty level.

When it comes to cutting costs like health care costs, we like to just, well, cut them. We don’t like to spend money to cut them, even if spending the money could mean huge future savings. We are weird that way.

The frustrating thing about this is that the medical home model pays for itself pretty quickly. Cutting back on visits for sickness (especially emergency room visits) or unnecessary specialist visits saves thousands of dollars per patient. Usually those savings go to the insurance companies, not the doctors or patients. But if we could get a little bit collective and creative, for example by persuading the insurance companies to cover some of those extra staff and services (which will ultimately give them even more savings), we could make this work.

Maybe it’s time we speak up. The more we make noise, the more likely things are to change.  Start demanding more from your doctor, your elected officials, your insurance company. Think of it as an Occupy Healthcare thing (there is such a movement–Google it and check it out).

The medical home model isn’t a fancy thing for the rich. It’s common sense health care that brings better health and saves money. You deserve it. We all deserve it—and need it.

4 thoughts on “The medical home: what health care needs now

  1. I feel blessed to be living this with my children.  I can get info as soon as  I need.  When I call, the Dr. answers.. I get follow up calls even when I think they are unnecessary..  and he does not have a large staff.. he just doesn’t take more patients than he can handle. 

  2. Thanks so much for posting about the benefits of a medical home, Claire.  It is essential that we build strong patient-provider relationships with the creation of medical homes, not just for pediatrics but also for geriatrics, as both Medicare and Medicaid promote very fragmented systems of care which are neither health promoting nor cost effective.

  3. Great post, Claire. Agree with Pamela that medical homes are essential for geriatrics. My mother’s new family practitioner took one look at her and made a diagnosis (borne out through testing) that an array of specialists missed (including a cardiologist who supposedly delivered primary care too). Unfortunately, the practice isn’t there yet with the electronic medical records.

  4. The Medical Home is the model for delivering high quality primary care.  Studies have shown that communities with higher proportions of quality primary care have better health outcomes, including both quality of life and cost of care.  Optimal patient- and family-centered outcomes occur when there is a close partnership between community-based primary care providers, subspecialists, and the families.  This partnership is enabled when there are resources which support integration of care across all providers, including care coordination services, electronic health records, easy access to subspecialty advice, engagement of patients and families as partners in their own care, and shared educational experiences for Medical Home providers.  The Pediatric Physicians Organization at Children’s (PPOC) is a group of 210 pediatricians, in 75 practices, which has committed to serving as a Medical Home.  Children’s Hospital is working closely with the PPOC to enable the key elements of care integration.  The quality and patient experience measures of the PPOC are highly favorable. 

    In support of its commitment to be the pediatric subspecialty partner of choice for Medical Home providers serving children and youth, Children’s Hospital is also working with multiple pediatric and family practice offices across Massachusetts to enable the spread of the Medical Home model of care.  The advent of health care reform brings with it the recognition that we must redesign care models to deliver higher quality care at lower cost.  The Medical Home model is at the foundation of health system improvement.

         

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