Can the Medical Home Concept Help Our Broken Healthcare System to Heal?

The Medical Home, also called the Patient-Centered Medical Home, and the Personal Medical Home, is a movement to solve the problem of fragmented care (one hand doesn’t know what the other is doing) by having a primary care physician or practitioner act as the center of all care information for the patient. Fragmented care is dangerous (lack of coordination of care causes mistakes and mistreatments), costly (repetition of diagnostic tests and regimens), and wasteful of healthcare resources. The Medical Home plan goals are to provide care for all individuals, improve care, and decrease healthcare costs.Crossing the Quality Chasm: A New Health System for the 21st Century was published in 2001 by the Institute of Medicine. In this landmark book, the patient’s role and responsibility for navigating the healthcare system and acting as the information hub around which the spokes of primary, specialty and tertiary care providers revolve was denounced as unreasonable and detrimental. Since 2001 the concept of the Medical Home, a focal point through which all patients receive acute, chronic and preventive medical services, has been the object of a number of pilot projects, most notably the CIGNA/Dartmouth-Hitchcock pilot project announced in 2008, a Blue Cross Blue Shield of Michigan project announced April 21, 2009 and the CMS Demonstration Projects.

On April 14, 2009, new White House Health Reform Director Nancy-Ann DeParle stated “There are very robust demonstrations of (the medical home) going on right now in the private sector. Some insurance companies are doing this already, and they have shown real promise. We hope to move forward with (the program) in Medicare.” DeParle also said “We want to move toward things that will bend the (cost) curve to create better incentives for physicians and hospitals to treat patients in a smarter way.”The main concepts embodied by the Medical Home are as follows:

Primary Care Provider: Patients choose a primary care provider who is always the first point of contact for all care, excluding emergency or trauma care. The patient calls this provider first for all concerns and does not contact other providers for any initial health care concern.
The Care Team: The primary care provider is the team leader for all care for the patient and is responsible for gathering other providers together for the benefit of the patient.

Coordinated Care: The primary care provider is responsible for the coordination of all care across all facets and places that treatment is rendered: inpatient, outpatient, testing, physical therapy and rehabilitation, home health, nursing home and hospice care.
Quality and Safety: All care providers are responsible for the use of electronic information technology to assure that treatment information and quality indicators are available to guide and assess care.
Open Access: Access to care is provided face-to-face, by telephone, via email, telemedicine and remote monitoring.
Payment for Performance: Providers who embrace the medical home concept and use it in a meaningful and results-oriented way will be rewarded financially.