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Thoughts on the Medical Home Concept

by JMcCabeGorman

We’re talking a lot about money and business models that work here at WHCC. We’re all looking for ways to implement consumer-centric care - how will a primary focus on the patient become embodied in our healthcare system?

One term mentioned repeatedly here at the congress which gives some hope for those seeking practical implementations and physical loci to “do” primary care well…next year I hope we see more presentations on creating a medical home (both virtually and in the ‘brick and mortar’ world) from companies that do it well, like Erickson Retirement.

The medical home is about primary care. Primary care puts patients “primarily” at the center of the care spectrum.

The medical home is about care coordination. Care coordination is about putting the patient “primarily” at the center of the care spectrum, and then ensuring they stay there as they seek services at different locations.

Unfortunately, “primary” patient-centric, consumer-directed care in the US has devolved into the desperate pursuit of paperwork needed for payment.

We shuffle patients through the system as quickly as possible. There’s no time for docs and nurses to talk with us about our care goals, much less cooperate with healthcare consumers to nurture a warm, fuzzy, familial connection built via belonging to a medical home.

The medical home concept has been thrown around a lot at The World Healthcare Congress this week.

Unfortunately, the fragmentation of healthcare is matched only by the fragmentation of legal localization (different state, different statute), an unfortunate complication to be sure.

This co-dysfunction will make it very difficult to establish a brick and mortar medical home - what if a patient travels over state lines?

This is also the reason we’re creating medical homes online - virtual PHAs (personal health applications) will rule the web and then they’ll bleed innovation offline. The elusive “killer app” mentioned by Dr. Jeff Gruen of HealthVault will drive that bloodletting - unfortunately no one knows when and from whence it will arrive.

Examples of existing brick and mortar medical homes are often culled from countries overseas - The Netherlands, New Zealand, and Switzerland win the awards for most mentions by panelists speaking on every topic here at WHCC.

But you don’t have to add a bunch of frequent flyer miles to view the medical home concept in action.

If you’re here at WHCC, you’re a 10-minute walk or a 5-minute cab ride from one of the best examples in the world.

Your destination, 1717 Columbia Road, is one of America’s few remaining medical homes.

Christ House is a 33 bed medical home serving people who are homeless in Washington DC.

My first experiences caring for populations with unique disadvantages developed here - as did a lifelong commitment to serving underserved populations and making sure every consumer of healthcare and wellness goods and services has a ‘voice’ in the system.

I hope all here, particularly policymakers and pundits based in the Beltway area, will take this open invitation to tour Christ House seriously.

Last night some coworkers from Christ House gathered to celebrate the life of one of our patients who passed away. This calm, smiling, quiet little man spoke many languages and desperately wanted to return to work.

I met him just before I left Christ House to move to Holland, but in his 4 months at Christ House my teammates there became his family. When he called back to the nursing station during one of his hospital stays, his closing line was: “I’m coming home soon.”

Here’s a call to action for healthcare organizations at WHCC.

Think, hard, about what it takes for patients to feel that sense of medical home…how do you make consumers feel like we’re coming home soon?


3 Comments »

  Dan Francis wrote @ April 24th, 2008 at 10:27 am

The Medical Home Model is the future of healthcare in America. But we cannot succeed by continuing to go about healthcare the same way we do now. It is a model full of benefits, but we named them all individually like disease management and personal health records, same day appointments and care plans. None of the componets are user friendly, using common terms and made to be comprehesible to the regular person in the world. It is absent of consistency and standard processes and procedeures that make all other industries successful. We go about it like buying a car, one part at a time, at retail prices. In every other industry these benefits are simply customer service. Can you even imagine going to a retail store of any kind and facinig the scutiny that insured individuals face with each healthcare interaction, each time you go to use your credit card. How about paying wall-mart every month for, well nothing if you do not have a need to go to that store. It is the pricipals of the retail and service/ hospitality industries that will create an enviorment that will sustain and promote the Medical Home Model. Pateint centered, consumer driven, would be elementary terms in those industries after all, how do you keep customers if you do not work to satisfy them and meet thier needs.
.
Retail philosophy will bring this change to the forefront!

Maybe we can look at what the ER really offers, 24/7 access, no payment scutiny, a wide variety of services in one place….sounds like a great place to go if you need help any time of the day or night. The ER is the Wal-Mart of medicine, that is why so many people use it. Not a lack of insurance, though this is certainly an issue, but lack of a better alternative in the community that they would rather utilize.
Medical Homes , if applied to the industry with a new point of view, the retail / hospitality point of view, will be successful.

Dan Francis, CEO
Medical Homes of America

  JMcCabeGorman wrote @ April 25th, 2008 at 12:17 pm

Dan -

Thanks so much for that excellent and thorough commentary.

It’s really true that EDs have become the “Wal-Mart of medicine.”

Like many others, I believe the medical home concept has real practical merit.

I think you’ll find this recent bit of news interesting with relation to ERs serving as medicine’s bargain basement, day-or-night provider…they’re doing such brisk business they can open as stand-alone clinics:

http://www.usatoday.com/news/health/2008-04-24-emergency-rooms-stand-alone_N.htm

  Dan Francis wrote @ April 28th, 2008 at 9:34 am

I did look at that article and enjoyed it very much. I was a partner in a facility like the one mentioned in the article, Chestatee Emergent Medical Care is open seven days a week, but not 24/7, they close at night. We also incorporated a membership for just $500 / year, which turned out to be our most efficient product to sell. This is how the Medical Homes Of America voucher system got started. Solantic in Florida, a project Rick Scott formerly of HCA is involed with, is going very well too.

I am a big believer that physicians can offer all of their skills to their community at the same prices they offer it to the insurance companies, and do much better in the long run for themselves and their patients.

Thaks for the link, It is an example of a portion of the industry that is not complaining about inappropriate use of the ER, but adapting to a consumer demand.

Dan Francis, CEO
Medical Homes of America

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