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Medical homes help manage chronic conditions such as diabetes, hypertension and heart disease.
Imagine having a team of health care professionals dedicated to keeping you healthy year-round by preventing the onset of diseases and managing your to avoid costly complications and hospitalizations.
That’s the mission of thousands of primary care practices nationwide that have embraced the “patient centered medical home” model that emphasizes prevention and disease management. Advocates say medical homes have the potential to improve quality, cut costs and reduce health inequities among all patients.
More than 9,000 primary care practices and 43,000 clinicians (doctors and ) across the country have earned the PCMH designation from the National Committee for Quality Assurance, the nation’s largest credentialing organization.
“Medical homes focus on patients even when they’re not present at the office. The team takes a proactive approach to health rather than waiting for patients to show up at the practice when they’re sick,” says Patricia Barrett, NCQA vice president of product delivery and PCMH.
“It’s about being there when patients are sick and reaching out to them to find out how they’re doing when they’re not sick,” says Salvatore Volpe, a primary care physician with a solo practice in Staten Island, New York, who operates a medical home.
What Is a Medical Home?
Medical homes refer to a way of delivering primary care that helps people stay healthy by keeping up with preventive care and managing chronic conditions such as diabetes, , hypertension and heart disease. In a medical home, a team of health care professionals partners with patients to coordinate every aspect of care. Providers use electronic tools to remind patients about screenings and track outcomes. Some insurers offer medical homes financial incentives for meeting quality and other standards.
Experts expect interest in medical homes to increase as health reform shifts the nation’s focus from illness to wellness. The Affordable Care Act requires insurers to cover preventive care at no out-of-pocket cost to patients and institutes payment reforms that financially reward health care providers who coordinate care.
Engaging Patients
Volpe, who has been at the forefront of the medical home movement for years, can’t fathom running his 25-year practice any other way.
His team spends significant time coordinating care, including contacting patients by email, text, phone or mail to make sure they follow-up with preventive care appointments and are successfully managing their chronic conditions. The team also works with specialists, nursing homes, hospitals, subacute care facilities, visiting nurse associations, nutritionists, therapists and other caregivers involved in a patient’s care.
The goal is to keep people healthy and manage disease when it’s easier and less costly to treat. For example, people with diabetes who get regular eye and foot exams can avoid the emotional and costly consequences of such as blindness and lower-leg amputations.
“The amount of money needed to take care of an illness can be 1,000 times greater than just helping people to stay well,” Volpe says.
At Volpe’s practice, patients have direct access to the health care team and their medical records via a that can be viewed on their smartphones, tablets or computers.
Technology also allows Volpe to identify health trends and monitor groups of patients, like individuals who are due for , colonoscopies, flu shots and more.
“With the technology, you can start slicing the patient population and looking at gaps in health care,” says Volpe, who is chairman of the NYS Medical Society health information technology committee and a consultant with the NYC Primary Care Information Project.
Payment Reforms
Some of the obstacles facing practices wanting to become certified medical homes – such as the cost of implementing an electronic medical record and hiring additional staff to help coordinate care – are beginning to wane.
In January, Medicare began paying primary care doctors a monthly management fee to coordinate care for who have multiple chronic conditions even if they don’t have an exam at the doctor’s office. Some experts believe Medicare’s move to reimburse chronic care management paves the way for more commercial insurers to begin paying primary care practices for coordinating patient care.
HealthyCT, a nonprofit insurer in Wallingford, Connecticut, is already offering financial incentives to a pilot group of primary care practices that provide coordinated care.
“Our model rewards those practices that improve quality and the health of their patients while lowering health care costs,” says Ken Lalime, HealthyCT’s chief executive officer.
Lalime said the decision to support medial home practices seemed natural given that HealthyCT was founded by a group of Connecticut physicians. As a “Consumer Operated and Oriented Plan” created by the federal health law, all of HealthyCT’s profits are used to enhance benefits and stabilize or lower premiums.
“We understand the value of providing preventive and coordinated care,” he says. “A $15,000 visit to the emergency department can pay for a lot of doctor visits.”
Patients are recognizing the value of medical homes, too.
“Consumers are getting more engaged in the process,” Lalime says. “They’re interested in models that help keep their costs down and allow them to better use their benefits. They’re receiving coordinated care at time in history when health care is very complex.”
More than 9,000 primary care practices and 43,000 clinicians (doctors and ) across the country have earned the PCMH designation from the National Committee for Quality Assurance, the nation’s largest credentialing organization.
“Medical homes focus on patients even when they’re not present at the office. The team takes a proactive approach to health rather than waiting for patients to show up at the practice when they’re sick,” says Patricia Barrett, NCQA vice president of product delivery and PCMH.
“It’s about being there when patients are sick and reaching out to them to find out how they’re doing when they’re not sick,” says Salvatore Volpe, a primary care physician with a solo practice in Staten Island, New York, who operates a medical home.
What Is a Medical Home?
Medical homes refer to a way of delivering primary care that helps people stay healthy by keeping up with preventive care and managing chronic conditions such as diabetes, , hypertension and heart disease. In a medical home, a team of health care professionals partners with patients to coordinate every aspect of care. Providers use electronic tools to remind patients about screenings and track outcomes. Some insurers offer medical homes financial incentives for meeting quality and other standards.
Experts expect interest in medical homes to increase as health reform shifts the nation’s focus from illness to wellness. The Affordable Care Act requires insurers to cover preventive care at no out-of-pocket cost to patients and institutes payment reforms that financially reward health care providers who coordinate care.
Engaging Patients
Volpe, who has been at the forefront of the medical home movement for years, can’t fathom running his 25-year practice any other way.
His team spends significant time coordinating care, including contacting patients by email, text, phone or mail to make sure they follow-up with preventive care appointments and are successfully managing their chronic conditions. The team also works with specialists, nursing homes, hospitals, subacute care facilities, visiting nurse associations, nutritionists, therapists and other caregivers involved in a patient’s care.
The goal is to keep people healthy and manage disease when it’s easier and less costly to treat. For example, people with diabetes who get regular eye and foot exams can avoid the emotional and costly consequences of such as blindness and lower-leg amputations.
“The amount of money needed to take care of an illness can be 1,000 times greater than just helping people to stay well,” Volpe says.
At Volpe’s practice, patients have direct access to the health care team and their medical records via a that can be viewed on their smartphones, tablets or computers.
Technology also allows Volpe to identify health trends and monitor groups of patients, like individuals who are due for , colonoscopies, flu shots and more.
“With the technology, you can start slicing the patient population and looking at gaps in health care,” says Volpe, who is chairman of the NYS Medical Society health information technology committee and a consultant with the NYC Primary Care Information Project.
Payment Reforms
Some of the obstacles facing practices wanting to become certified medical homes – such as the cost of implementing an electronic medical record and hiring additional staff to help coordinate care – are beginning to wane.
In January, Medicare began paying primary care doctors a monthly management fee to coordinate care for who have multiple chronic conditions even if they don’t have an exam at the doctor’s office. Some experts believe Medicare’s move to reimburse chronic care management paves the way for more commercial insurers to begin paying primary care practices for coordinating patient care.
HealthyCT, a nonprofit insurer in Wallingford, Connecticut, is already offering financial incentives to a pilot group of primary care practices that provide coordinated care.
“Our model rewards those practices that improve quality and the health of their patients while lowering health care costs,” says Ken Lalime, HealthyCT’s chief executive officer.
Lalime said the decision to support medial home practices seemed natural given that HealthyCT was founded by a group of Connecticut physicians. As a “Consumer Operated and Oriented Plan” created by the federal health law, all of HealthyCT’s profits are used to enhance benefits and stabilize or lower premiums.
“We understand the value of providing preventive and coordinated care,” he says. “A $15,000 visit to the emergency department can pay for a lot of doctor visits.”
Patients are recognizing the value of medical homes, too.
“Consumers are getting more engaged in the process,” Lalime says. “They’re interested in models that help keep their costs down and allow them to better use their benefits. They’re receiving coordinated care at time in history when health care is very complex.”