Sunday, February 14, 2010
Among the many ideas for potential solutions for what ails our healthcare system is an idea referred to as Patient Centered Medical Homes. No, this does not refer to changes in the building codes that might improve health outcomes. Rather it refers to a model of healthcare delivery that facilitates partnerships between patients, their personal physicians and family members. The concept is not new. It was originally introduced in the late 1960’s, but it was not until 25 years later in 1992, that the American Academy of Pediatrics first defined what a medical home actually was. Ten years later in 2002 that definition was revised and expanded. That same year the nations Family Medicine physicians introduced the recommendation that every person should have a medical home where patients could obtain all needed high quality services in the same place, in settings that are patient oriented and physician driven. By 2005 an “Advanced Medical Home” model was developed that involved, among other things, the use of electronic decision support tools and health information technology for healthcare providers. In 2006 IBM and eventually some 500 other business organizations began promoting the Medical Home as an important model to help improve health and drive down healthcare costs for the nations largest businesses through what became known as the Patient-Centered Primary Care Collaborative. Finally in 2007 the nations leading primary care physician’s organizations came together and released the “Joint Principles” of the Patient-Centered Medical Home. These principles are 1) each patient should have a single personal physician that ideally would be with that person from birth to death. 2) The personal physician is the leader of a team of individuals who collectively care for patients. 3) the personal physician is responsible for all aspects of a patient’s healthcare needs or arranging needed services found elsewhere 4) All healthcare is coordinated and integrated across care settings (hospitals, nursing homes and home health agencies) 5) Quality and Safety of services is a priority that is enhanced via HIT tools for physician decision support 6) Care is available whenever a patient needs it, regardless of the patient’s ability to pay 7) Physician reimbursement and payment enhancements should accompany and reward improved outcomes and additional investments. Undoubtedly these 7 principles would lead to improvements in our healthcare system. Indeed several early studies suggest a benefit, and now through the stimulus funds from the US government, considerable funds are pouring out to finance and encourage the initial investments, start up costs and sustainability of medical homes throughout the country. But what impact will this model have on healthcare disparities? Several authors have suggested that it would reduce disparities, however the scientific basis for this assertion appears weak at best, and a close inspection, strongly suggests that it is unlikely that this model alone will improve disparities. However we can have cautious optimism, if we go forward including in the patient centered medical home model, what we already know will help reduce disparities in healthcare outcomes. Click back for my future blogs when I will discuss the challenges faced and promising strategies for going forward and reducing healthcare disparities within the context of the Patient Centered Medical Home.