Vertigo – that whirling, unsettling sensation when all coordinated effort fails, like stepping onto an untethered boat without a rail. Not unlike trying to navigate the American health care system.
Health care professionals mean well, but our health care system has become convoluted, patched and ill-packaged.
While no one set out to create this fragmented system, a collaborative effort by the professional associations of pediatrics, family medicine and osteopathy has presented a new concept that could bring us to the goal of care coordination, expanded access, comprehensive use of community resources and integration of information technology for safe and quality medical care.
That concept is the Patient-Centered Medical Home.
According to the American Academy of Physicians, a Patient-Centered Medical Home is "a team-based model of care led by a personal physician who provides continuous and coordinated care throughout a patient's lifetime to maximize health outcomes…It is a model of practice in which a team of health professionals, coordinated by a personal physician, works collaboratively to provide high levels of care, access and communication, care coordination and integration, and care quality and safety."
Who makes the team?
A Medical Home team's first member is the patient's personal physician – a primary care doctor, such as a family physician, a general internist, or a pediatrician – who creates an ongoing relationship with the patient, whether sick or not.
The personal physician serves as a patient's first point of contact and commits to managing continuous and comprehensive care with a multidisciplinary team. He or she coordinates care between hospitals, specialists and health-related service providers patients might need.
A patient's team could include nutritionists, educators, mental health providers, exercise therapists and any appropriate provider who can contribute to lifestyle modification and support for, say, chronic diseases such as diabetes or obesity.
This system will depend on integrated electronic health records and interactive websites that make data collection and tracking and privacy protection easier. This also enables secure access to medical records, online communication, scheduling and the ability to have same-day appointments.
As a business model, the current health care system is skewed toward rewarding disease management and the administration of procedures, tests and specialization – treatment of those who are already sick – thereby rewarding more care.
The new medical home model would reward disease prevention and patient self-management – comprehensive care. Studies by the National Institutes of Health support this as both cost-savings and quality-improvement measures.
Getting there
The medical home is a new way to think about health care and it will require changes in medical training, systems and structures (such as the employer-based health insurance system). These are daunting tasks, and not without costs, though the ultimate cost savings and related improved care could be impressive.
Many demonstration projects evaluating this system are underway. The websites for the American College of Physicians, the American Academy of Family Physicians, the American Osteopathic Association and the American Academy of Pediatrics include several.
Dr. Rebecca Hoffman owns Great West Family Care PC, a primary care medical practice in Salmon Creek, and is president-elect of the Clark County Medical Society. She can be reached at 360-574-9730 or www.gwfamcare.com.
