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.