insurance

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."

Medical home idea isn't a new one

The American Academy of Pediatrics is credited with introducing the concept of the medical home in 1967 as a place for centralizing all of a child's medical records. In 2007, that academy and three other primary care doctor groups -- the American Academy of Family Physicians, American College of Physicians and the American Osteopathic Association -- adopted joint principles that set in motion the migration toward today's medical homes.

The aim, admittedly self-serving, was to return family doctors to their rightful place as coordinators of family medical care -- and save them from extinction.

"Primary care doctors were getting squeezed under the fee-for-service system," says Dr. Trent Haywood, chief medical officer of the Blue Cross and Blue Shield Association in Chicago. "The current system rewards doctors who do a lot of volume and a lot of procedures; it doesn't make it advantageous from a financial standpoint for that primary care doctor who wants to slow down and talk about coordinating your care."

The timing for modern medical homes was perfect. The cost of health care in the U.S. was skyrocketing while survey after survey showed no improvement in Americans' well-being. Medical students and practitioners alike were leaving primary care in favor of more sustainable specialties. And 70 million baby boomers were fast approaching an age at which chronic disease begins to cost insurers big-time.

Gradually, health care is going 'home'

Major health insurers including Blue Cross and Blue Shield, Anthem/WellPoint, Aetna and Cigna have eased into the medical home movement, even if it has meant compensating participating family doctors for coordinating their patients' care.

"The main issue is to move away from fee-for-service payments," says Susan Pisano, spokeswoman for America's Health Insurance Plans, an industry trade group. "Health plans believe that the fee-for-service model is not working."

While the shift to medical homes is still in its early stages, initiatives are underway in 48 states and the District of Columbia, according to Pisano's group.

Look for a medical home close to home

To find a medical home near you, contact your health insurance company or find the website of the National Academy for State Health Policy, which features a map showing pilot medical home programs by state. Or check with your state department of insurance; some states such as Minnesota offer online search engines for medical homes.

Haywood says Blue Cross and Blue Shield is already seeing health care savings from its medical home initiatives, savings that will be passed on to patients.

"The goal of all this is to maintain a high level of quality, make sure that the experience is positive for the individual insured member, and that members also save money in their own pockets," he says. "Whether you call them medical homes or something else, you'll experience that difference. The hope is that one day, we'll refer to this simply as going to the doctor."

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