Medical Homes
Friends,
The term “Medical Homes” has recently become a focus for discussion in health care. While the term is currently one of the hot buzzwords in the medical community, Medical homes have been in place in various forms since the 1960’s.
A Medical Home is defined by such components as; adoption of health information technology and decision support systems, the modification of clinical practice patterns, and ensuring continuity of care. Each of these components is a complex undertaking. With that said, policy-makers seeking to encourage the development of medical homes, providers seeking to improve patient care, and payers seeking to create more efficient systems of patient payment distribution will face many obstacles relative to the dissemination of the medical home model.
The medical home concept requires practices to redistribute the tasks of providing patient care, and is tied tightly to the philosophy of building patient self-efficacy as opposed to simply providing advice.
As short a time ago as the 2003, patients were still receiving only half of the chronic and preventative care indicated for their conditions. Reacting to this startling high statistic the American Academy of Family Physicians (AAFP) in 2004 called for the creation of “a personal medical home for each patient
This call to action was made with the singular goal of providing high-quality patient-centered care. The new methodology was designed to provide integrated, comprehensive, care through an ongoing relationship.”
Accompanying the advocacy of medical homes has come simultaneous demands for rigorous standards for monitoring and evaluation of the practice. This is not an easy task as the complex nature of the medical home poses a challenge to health researchers.
How to best evaluate “a collective basket of patient services and even more confounding: how to define its contents and measure them” is a question that has not yet been addressed. Beyond that both researchers and physicians must determine what outcomes can best measure the wide benefits anticipated by medical home advocates.
The AAFP model of the medical home would provide “a basket of acute, chronic, and preventive medical care services” for each patient, and would serve as a singular repository of patients’ health-related information.
The list of people affected by how these concepts are defined is long. Physicians will need detailed direction for redesigning their medical practices. Payers will need specific criteria for reimbursement. Policymakers will need end points constructed of hard fact to monitor and evalute success or failure of medical homes.
Many groups are expressing interest and support for medical homes. Most if not all supporters are asserting that improved care and decreased costs will arrive hand in hand with their adoption.
Even with that said, every element of the medical home warrants further research, and adoption of most will demand considerable effort or and most likely, financial risk on the part of providers themselves.
Providers, researchers and advocates are just starting to determine what actually constitutes a medical home and if they will in fact, improve health care in the short and/or long run.
I encourage all concerned citizens and fellow physicians to research medical homes and their effects on healthcare.
Sincerely,
