Spinning a Consumer Perspective of the Medical Home Model
By Emily Mullin
July 31, 2012
The U.S. Centers for Disease Control and Prevention estimates that nearly half of Americans are living with at least one chronic disease, such as heart disease, obesity, stroke, cancer, diabetes and arthritis.
To better manage these patients and boost health outcomes, a number of private and public initiatives have launched in recent years. One of those, the medical home, shows considerable promise in improving the quality of care and reining in healthcare costs.
Studies have consistently shown that a patient-centered approach to primary care benefits patients, especially those with chronic and complex diseases. By taking a preventive rather than reactive approach to healthcare, providers can help reduce unnecessary emergency department visits and avoidable hospitalizations and readmissions, translating to lowered morbidity, mortality, lost days of productivity, and costs for the U.S. healthcare system at large.
Focusing on these issues, healthcare accreditation body URAC released its latest report, The Medical Home: A Consumer's Perspective, in July. The report examines the patient-centered model of coordinated primary care, outlining the potentially dramatic improvements it could make to health and wellness, and provides consumers with the helpful information they need to manage their doctors' office visits.
A recent study from the University of California, Davis, confirms the benefits of the medical home. The study, which appeared in the Annals of Family Medicine, found that that three basic tenets of the medical home model – comprehensive patient care, patient-centeredness and extended office hours – correlate with a longer lifespan among patients.
The Patient Protection and Affordable Care Act and other federal-backed initiatives have invested more than $40 million in grants to bolster the expansion of the medical home. In 2011, URAC released its Patient Centered Health Care Home (PCHCH) program to meet the needs of this increasingly popular healthcare delivery option.
“In many ways, the medical home model helps primary care physicians in that it pulls from administrative duties that have bogged down their practices and puts them in front of a team of practitioners equipped to track a patient across their lifespan,” the URAC report says.
A medical home team may include a registered nurse, care manager, health educator and social worker. This network helps bridge the gap between the patient and primary care physician, and it helps prevent unnecessary visits to the emergency room or acute care clinic that can create gaps in a patient’s care plan – not to mention a more expensive episode of care.
URAC’s PCHCH focuses on healthcare that is not limited to disease and works to provide comprehensive and individualized access to physical health, behavioral health, and supportive community and social services, ensuring patients receive the right care in the right setting at the right time. The program recognizes that patients are consumers and that the healthcare team and health plan are their partners, helping patients to safely navigate the healthcare system.
“Part of the difference between the medical home model and models of the past is marked by a newfound focus on the wants and desires of the consumer,” the report says.
The report outlines medical home models that have bolstered care and resulted in returns on patient engagement or satisfaction. One of those models, developed at Johns Hopkins Bloomberg School of Public Health, is known as Guided Care, which uses a nurse care coordinator that works directly with patients, often in a one-on-one, home-based setting. The nurses target the over-65 population by conducting community outreach, providing education about disease self-management and alerting patients to early warning signs that signal a worsening disease state.
Data shows that on average, the initiative has rendered 24 percent fewer hospital inpatient days, 15 percent fewer visits to the emergency room, and a 37 percent drop that patients spend in a skilled nursing facility. Guided Care patients also were twice as likely as usual care patients to rate their care highly.
Another program, CareOregon, a managed care plan in the state of Oregon, developed the Primary Care Renewal project. Using team-based care consisting of physicians, medical assistants, care managers and behaviorists, the initiative has reduced hospitalizations by 16 percent. It also improved diabetes metrics, increasing the number of patients with “good control of the disease” by 20 percent. The program drastically reduced the average wait time from 17 days to three days. In addition, patient satisfaction scores show that six out of 10 patients ranked their patient care experience as a “9” or “10” on a scale of 1 to 10.