Barrosse Schwartz – The Medical Home

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Vital Signs: Vermont Charts A New Course For Health Care

(HOST) The effort to revamp health care is focused on improving care and controlling costs.  Commentator Mary Barrosse Schwartz believes one approach to providing care promises to do both.  

(BARROSSE SCHWARTZ)  Health care reform is often fraught with controversy. Issues involving the high cost of end-of-life care, single vs. multi-payer approaches, and how to deal with spiraling costs will be debated across the country for years to come. But, there is one approach to providing better care and a lower cost, and it is so straightforward and sensible it enjoys support from patients, physicians, health care policymakers, insurance companies, and taxpayers.

The concept of the patient-centered medical home is simple. Provide support for patients, families, and primary care providers by centralizing care and record keeping in the primary care clinician’s office. Then, instead of only treating patients when they are sick, the system relies on a team approach to supporting good health.

Because primary care clinicians are the first stop for many patients seeking care, providers must have a broad knowledge of many health care conditions. These doctors see patients for many years, and develop strong relationships.  They have an ability to track care over time. When referring patients to specialists, primary care clinicians can be at the center of the communications hub.

Providers who participate in the medical home program in Vermont need to go through a certification process to show they are high quality. Once approved the practice gets paid differently.  The physician still submits a bill to insurers, but also receives an additional payment for each patient. It can be around $1.50 per patient in the practice, per month. This is new money provided by commercial insurers, Medicaid, and now through a new program in Medicare.  The providers can decide how this extra funding is used – whether for a new support person, for equipment, or for some other use.

The provision of medical homes may allow better access to health care, increased satisfaction with care, and improved health because the goal is to keep a strong focus on integrating care with supporting healthier behaviors. The patient-centered medical home provides a team of people who can coordinate services not just for chronic disease management, but for preventative care as well.

This team is supported through another stream of medical home funding, supporting a multidisciplinary community health team, often involving dieticians, nursing, and community health workers, who move around among local practices. The teams provide supports as diverse as exercise programs, help for homelessness, transportation, and weight loss counseling. The teams are currently in Bennington, St. Johnsbury, Burlington, Mt. Ascutney, and Central Vermont.

Just as patient-centeredness is important, so is the centralized record keeping. Patients with chronic illnesses often have a vast amount of clinical details to be managed. This can be very challenging using paper.  For this reason, more and more practices are turning toward electronic medical record systems, to use technology to help coordinate patient care.

Vermonters are fortunate that we have policymakers and health care clinicians who are looking for innovative ways to serve patients and families. The patient-centered medical home seems to be a great place to start. 

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