Although I really plan to explore issues around safe discharge home from the hospital, I couldn’t resist a brief detour to find out more about the “Medical Home” model of medical practice. As the Keckly and Underwood paper puts it, U.S. Healthcare is on a “burning platform”. An ageing population and increasing rates of chronic illness (diabetes, obesity, heart disease to name a few) conspire to overwhelm our present system.
Keckley PH, Underwood HR. The medical home: disruptive innovation for a new primary care model. Washington, DC: Deloitte Center for Health Solutions, 2008. Accessed 2009 Jul 6.
What is a Medical Home?
More formally known as the Patient Centered Medical Home (PCMH), the model has seven principles:
-A patient will have a personal physician
-This physician will lead a team who will be responsible for the outcome.(reduced ER/hospitalization, improving A1c level, etc).
-PCMH is holistic in its approach to the patient
-Care is coordinated and/or integrated by primary team across Healthcare spectrum
-Quality and Safety are assured by Care Planning, evidence based medicine (EBM), clinical decision support tools, etc.
-Open scheduling (Walk-ins) expanded hours and telemedicine enhance access.
-The physician and the team get paid for results, for time spent with the patient, and for the usual tests.
American Academy of Family Physicians, American Academy of Pediatrics, American College of Physicians, and American Osteopathic Association. Joint principles of the patient-centered medical home. 2007 Mar
On the ground, running
United Healthcare is testing the idea in Arizona. UHC’s biggest client IBM is encouraging the test. As this article points out, IBM (and I bet the rest of business) is tired of paying more and getting less.http://www.nytimes.com/2009/02/07/business/07medhome.html
United Healthcare is also testing the model in Maine and Colorado. UHC believes in getting ahead of the ball.
It’s exciting stuff. The Deloitt paper shows ROI is possible. Read The medical home: disruptive innovation for a new primary care model. For an in-depth look at how the Medical Home model can improve our healthcare.
The USA Today http://www.usatoday.com/news/health/2008-07-13-medical-homes_N.htm article is a quickie. The NYT article is medium depth.
Will Hospitals ?
My question is “Will Hospitals position themselves to become the Medical Home for their communities? ” The plan requires a ton of IT infrastructure (electronic records, telemedicine, etc) and the hospitals are in position to play.
The House Healthcare bill has $6 Billion earmarked for PC-MH.