MMA Viewpoint
The Value of a Medical Home
One of the great joys I’ve experienced during my 25 years of providing pediatric care has been working with families and watching their children grow and develop.
I find deep satisfaction in getting to know my patients and understanding their specific needs. Although I spend most of the time in my practice trying to solve acute problems and counseling my patients, sometimes I need to use my clinical skills to the fullest to make a difficult diagnosis—for example to determine whether an irritable, feverish child has otitis or meningitis. I have to understand the limits of my skills in such situations and recognize when it’s time to refer my patient to another specialist. Then I follow up and track my patient’s progress.
Such coordination of care is at the heart of the medical home concept—one of the pillars of the MMA’s health care reform proposal.
A medical home is where all of a patient’s care comes together. Under the medical home model, the physician and all other caregivers know the patient’s medical history, needs, and circumstances. In addition to providing preventive care and disease management, the medical home team coordinates the patient’s care given in other settings such as hospitals and specialty clinics. Ideally, medical homes even link the patient with social services and community resources.
The medical home model has many advantages. It fosters an ongoing physician-patient relationship that creates trust and makes it more likely that patients will be forthcoming about their symptoms, take their medications, and follow their care plans. Patients are given the information they need to make wise decisions about their care.
A medical home ensures that specialists, primary care physicians, patients, and their families communicate with one another. This prevents errors and improves patient care. Administrative systems track and monitor each patient’s progress so nobody falls through the cracks. Such disease management can prevent dangerous and costly medical emergencies especially for the chronically ill. In the long run, investing time and resources in care management will save money because chronically ill patients and those with complex diseases generate the vast majority of medical expenses. More than 70 percent of health care costs are incurred by about 30 percent of patients.
The MMA, along with the Minnesota Academy of Pediatrics and the Minnesota Academy of Family Physicians, has been at the forefront of promoting the medical home concept. Now the idea is gaining traction in health care reform discussions among policymakers and legislators.
If the medical home concept is to succeed, however, payment systems need to be restructured to support functions such as educating patients and managing their care. Today’s system tries to save money by extracting deep discounts for most primary care. This is counterproductive. It keeps physicians from investing the time and resources necessary to prevent illness.
Another change needed if the medical home concept is to suceed is for employers, the government, and health plans to adopt payment plans and enrollment policies that will make it more likely that patients can maintain a long-term relationship with their physician and medical home team.
The MMA will continue to promote the medical home concept—to explain its long-range benefits and to urge policy makers to enact the changes needed to support it. Patients are and must continue to be our focus. The medical home helps us maintain this focus as it helps them through a disease process.