The “Medical Home” – It’s So Hot Right Now.

Ever have one of those weeks where you hear a band for the first time on Monday, and by Friday you just can’t walk five steps without being aurally accosted by them? Then you wonder whether you’ve actually been either: a) completely oblivious to a major change in the cultural zeitgeist (say, you missed the Beatles on Sullivan) or b) you wisely ignored a vapid fad that the trend-sters jumped on (say, the Macarena). Welcome to my last week and the term “patient-centered medical home.”

So, a primary-care medical home is a new primary-care framework wherein a physician-directed practice provides “accessible, continuous, comprehensive, and coordinated [care] ... delivered in the context of family and community.” Moreover, medical homes would provide patients, for an additional fee, coordinated and continuous management of a chronic medical illnesses. They serve to form a “primary source of access to basic primary care services, allowing PCPs to provide a source of confidence, advocacy and coordination for patients among the fragmented and disjointed health care system.”

If this is confusing, don’t worry. To be fair, most people don’t really know what a medical home means. A recent Health Affairs article notes that there needs to be a “broader consensus on what medical homes reasonable can be expected to accomplish, and how they can be best developed.”

Overall, the movement behind medical homes seems good to us public health people because of the intent to promote increased medical efficacy and primary care / preventive interventions. Furthermore, coordination of services for patients would reduce costs and errors from redundancy.

Challenges of the patient-centered medical home include the normal stumbling blocks of doctors trying to lobby for preventive services against acute clients. Moreover, it would require a larger primary care center and advanced IT to do this increased coordination, which would be tough for small group PCP practices. Also concerns exist whether PCMHs should target sub-populations and thus risk overspecialization. Furthermore, doctors worry that PCMHs, by expanding primary care beyond the individual to population needs and preventive interventions, run the risk of overstretching the bounds of primary care, thus reducing the effectiveness of primary care in traditional interventions.

All in all, I can see both sides of the issue. The question remains whether this will really decrease costs, and increase quality and effectiveness. On the latter two points, I can say that with my previous work with high-risk homeless substance abuse clients, the intensive case management, similar to the PCMH model, showed surprisingly good outcomes. However, I don’t know if what works for the … interesting clients I used to work with will Grandma Bessie with diabetes in Tuscon.

Issues, concerns, comments?

For further reading, c.f. the following articles and blog which I based most of this post around (and quoted from, natch). The blog I've found is a good update on the health policy world.