Medical homes: Where coordinated care 'resides'

The beloved family doctor who once coordinated your medical care, took late-night phone calls and guided you reassuringly through the health care maze largely disappeared about the time the iconic TV series "Marcus Welby, M.D." went off the air in the mid-1970s.

Why? Because our modern medical "fee-for-service" payment system that rewards doctors for treatment quantity over quality has provided little financial incentive for them to manage your care the way Dr. Welby once did.

But today, a growing number of physician groups, major health insurance companies and the federal government are working together to revive the caring family doctor through a technology-driven teamwork approach known as "patient-centered medical homes" -- medical homes, for short.

The name can throw you

Don't let the name confuse you -- a medical home involves neither home health care nor nursing homes, although both may fall under its purview. Instead, think of it as a "home" for all your health care needs and records. It will look in most respects exactly like your current doctor's office. The main difference you'll notice is there will be a greater focus on your individual needs by a team of practitioners headed by your primary care physician, and they'll be available day and night in numerous ways.

"A medical home focuses on meeting each patient's unique needs, culture, values and preferences," explains Deborah Peikes, senior fellow and medical homes expert with Mathematica Policy Research in Princeton, N.J. "It's comprehensive in dealing with a patient's physical and mental care needs: prevention, wellness, acute care and chronic care."

Healthy people, not hospitalized people

The No. 1 goal that unites physicians, insurers and consumers behind medical homes is surprisingly simple, Peikes says: Keep people out of hospitals.

"The idea is, provide better care earlier on so people stay healthier and can avoid going to the hospital," she says. "Hospitalization is the biggest cost driver in health care -- all told, it's usually 60 (percent) to 70 percent of total costs. That's a big lever to push."

Amy Gibson, chief operating officer for the Patient-Centered Primary Care Collaborative, an organization of medical home advocates, says teamwork and technology will combine to provide more answers when you need them.

Primary care more like the Apple store

"Being able to contact (doctors) by email, phone or text message without having to go to the emergency room or hospital is a big, big part of this," she says. "It doesn't mean your primary care physician is available to you 24/7. It means that somebody on your team who has all the information about your care and can help you make good decisions is available to you 24/7."

Gibson says there's a shopping-mall parallel for how a medical home might feel: the Apple store.

"When you walk in, you get great customer service, they ask you what your needs are, direct you to the right person on the team to get your needs met, and if you really need to see the specialist, that's there, too," she says. "That's why it's called a 'patient-centered' medical home. For once, your needs come first."