Monday Medical: Everyone needs a medical home |

Monday Medical: Everyone needs a medical home

Brian Harrington, MD, MPH, FAAFP

“Home is the place where, when you have to go there, they have to take you in.”

– Poet Robert Frost

We all need a home. Discussions about Steamboat Springs housing often invoke the belief that a healthy community requires decent, affordable homes for everyone who lives here.

Homes provide comfort and safety, are a place where we keep important personal items, have what we need to live our lives, and are where we interact with people we know and trust. In much the same way, people need a medical home for health care.

A patient-centered medical home provides an ongoing relationship and partnership with a personal physician who provides continuous and comprehensive primary care. This concept offers an alternative to the increasingly fragmented American health care system, which often requires patients to navigate a complex and confusing system on their own.

Karen Campbell, now a Steamboat resident, relates how her health care experiences with several different providers in a larger city were disjointed and impersonal.

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“They didn’t seem to know you. We had to start over with each one,” she said.

In the medical home model, a personal physician, chosen by the patient, would be responsible for coordinating care between various subspecialists and health providers and would serve as a patient advocate.

Research by Barbara Starfield, MD, MPH, of Johns Hopkins University, and others, has documented that having a medical home with a primary care provider is associated with better health and reduced costs. Patients who have a medical home also get better preventive care. Patients in medical homes report they get more of the care they need, when they need it.

The term medical home was first proposed by the American Academy of Pediatrics in 1967 to describe a central location for keeping a child’s medical records. The concept since has evolved to include patients of all ages.

In 2007, the American Academy of Pediatrics, the American Academy of Family Physicians, the American College of Physicians and the American Osteopathic Association joined together in a statement of principles. A patient-centered medical home should include the following:

1. Personal physician – an ongoing relationship; provides first contact, continuous and comprehensive care

2. Physician-directed health care team – responsible for ongoing care

3. Whole person orientation – provides for all of the person’s health care needs, or takes responsibility for arranging care with other qualified professionals

4. Coordinated care – navigates a complex health system and the patient’s community

5. Quality and safety – use of evidence-based medicine, continuous quality improvement and information technology

6. Enhanced access – same-day appointments, expanded hours, easier communication

7. Reimbursement – the resources and time needed to create and maintain a medical home are recognized as valuable

Information technology plays a key role in implementing the medical home. Electronic medical records help manage patient care. Computerized databases can track which children have missed immunizations or whether every patient with diabetes has had an annual eye exam.

This technology also can enable patients to access their own medical records and test results from a Web site. Making a doctor appointment on a clinic Web site already is possible in Steamboat Springs.

E-mail can be used in the patient-centered medical home to communicate more easily with your health care team. Gary Hay recently retired to Steamboat Springs after a career in the aviation business but still travels often.

He finds that “communicating by e-mail with my physician is especially convenient when I am out of town,” and is an “extraordinary” health care communication tool.

The medical home concept is even becoming law. In 2007, Colorado Senate Bill 130 stipulated that all children covered by Medicaid and SCHIP, and their families, should have a medical home. The U.S. Congress has approved reimbursement for selected practices serving Medicare patients that now meet medical home criteria.

While the medical home concept is not new for primary care specialists, it does challenge us to make changes in how we provide health care. The patient-centered medical home model offers a way to improve health care in America while at the same time reducing overall costs.

Everyone needs a home, even a medical home.