Medical Home Concept Still a Work in Progress, Panelists Say

The verdict is still out on whether a patient-centered medical home really can turn out to be a home, sweet home for patients and providers as well as achieve measurable cost savings and higher-quality health care.

But experts who are working on the concept and also researching the outcomes said at a Capitol Hill briefing Friday that they’re willing to keep plugging away despite the hurdles. “Change is hard,” said Barbara Tobias, medical director of the Health Collaborative of Greater Cincinnati, which includes a medical home program.

Physicians in medical home models need to “not just lead teams but work effectively as members of teams,” said Tobias, who’s also a professor at the University of Cincinnati College of Medicine.

It is a culture change for doctors who often have an “oldest child” syndrome of wanting to direct everything, but “I think ultimately this is the kind of system we want to practice in,” she said.

Patient-centered medical homes are a model of primary care considered an ingredient in the transformation of the U.S. health care system. They are made up of teams of health care providers who coordinate care and are proactive in reaching out to patients rather than waiting for patients to come to them, panelists said at the briefing sponsored by the Alliance for Health Reform. In demonstration programs, either the government or insurers often chip in money to physician practices to help make changes.

That means, for example, that doctors figure out ways to free up time in their schedules so patients can make same-day appointments and wait times are brief. Consultation is available over email or on the phone, and offices are open outside traditional work hours. Patients engage in decision-making with their doctors in active discussions.

Melinda Abrams, vice president at the Commonwealth Fund, said the idea is attractive because so many Americans have problems finding a primary care doctor and find inefficient and uncoordinated care when they enter the health care system. At the same time, primary care doctors are working on what one audience member described as a “hamster wheel” of longer hours for lower wages, and young residents are not attracted to such a regime.

A January report by the Commonwealth Fund proposed policy options for cost savings in the health care system totaling $2 trillion over 10 years, and a quarter of that was tied to changes in the primary care system, said Abrams. Commercial health plans in 49 states are testing medical home pilot programs.

Patient-centered medical homes are “the vehicle right now to strengthen primary care,” Abrams said...