What's All This Talk about Patient-Centered Medical Homes?
The U.S. health care system currently spends more dollars than any other country in the world; however, we do not enjoy better quality outcomes as measured by mortality and consumer/patient overall satisfaction. We have problematic quality, service, and resource stewardship outcomes on national, regional and local levels.
Increasingly, health care stakeholders are seeking alternative approaches to health care delivery to improve our system and reduce cost. At present, physicians and clinicians receive strong financial incentives to deliver more complex care and are penalized for developing more efficient and preventive methods for improving health. More care does not necessarily mean appropriate or efficient care, and often results in overuse of advanced imaging, repeated blood tests, and unnecessary procedures. "Patient-centered medical homes" offer a different approach to care.
The premise of patient-centered medical homes is that improved management of patients' preventive care and chronic conditions in the primary care setting will reduce unnecessary specialty and tertiary care, and improve health status, so that healthcare costs are decreased. The medical home model relies on the notion that the best quality of care stems from patient-centered, medical team-guided, cost-efficient care across all spectra of care. Care is coordinated and includes preventive/wellness care, chronic disease management, and urgent and same-day access to care, as well as pregnancy, mental health, and health education services.
A patient-centered medical home provides comprehensive primary care services that facilitate communication and shared decision making between the patient, his/her primary care providers, other providers, and the patient's family. Studies show that patient-centered medical home model can lead to increased immunization rates, reduced emergency department use, and increased preventive care visits, and lead to a reduction in affiliated practice costs.
The patient-centered medical home model has led to a 20 percent reduction in hospital admission and seven percent savings in total medical costs. Patients in medical home experienced 29 percent fewer emergency visits and six percent fewer hospitalizations. More than 100 medical home initiatives aimed at supporting primary care and chronic disease management have emerged over the last few years.
Enrollment in the medical home may vary slightly (i.e., patients may actively enroll or be automatically or invisibly enrolled). Some medical homes are disease-specific (such as high risk) or general primary care. The critical piece of all patient-centered medical homes is the person and family, who serve as the center and key drivers of quality health.
In a medical home, individual/family empowerment is emphasized with the interdisciplinary clinical team working to promote health, based on the person/family’s health literacy and self-efficacy. While new strategies are developed to curtail healthcare spending, medical homes offer a coordinated approach to care to reduce spending and improve health quality for families.
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Kameka Brown serves as vice-chair for the Mayor's Council of African American Elders. She is a clinical program consultant for Premera Blue Cross and an independent health consultant and facilitator for Brown Clinical Consulting, LLC.