The concept of the Medical Home, often referred to more fully as the Patient Centered Medical Home, is not brand new. It was originally introduced in the 1960s, focused primarily on the field of pediatrics. There are still significant implementations of the concept in that field. However, it has evolved quite a lot since then.
One of the first and most important elements of the concept is that it is not about a place. Rather, it is about a health care delivery model and process that conforms to a global set of principles and attributes:
- Health care delivery must be comprehensive. As the federal Agency for Healthcare Research and Quality states, “The primary care medical home is accountable for meeting the large majority of each patient’s physical and mental health care needs, including prevention and wellness, acute care, and chronic care. Providing comprehensive care requires a team of care providers. This team might include physicians, advanced practice nurses, physician assistants, nurses, pharmacists, nutritionists, social workers, educators, and care coordinators.” This list is not all-inclusive. In our view, professional and family caregivers are a critical part of that team, as well. Indeed, non-clinical caregivers are likely to be with the patient far more than any other service provider and will be a critical source of service delivery and information flow.
- The Medical Home team must be patient-centric and focused on the “whole person”. That means, “understanding and respecting each patient’s unique needs, culture, values, and preferences” is a critical component of health care delivery. The family, where present, and caregivers again form a vital link in the chain, especially if the patient has a condition such as dementia, which prevents them from playing a lead role in communication.
- Care must be coordinated. Some individual or entity, within the Medical Home team, must coordinate “care across all elements of the broader health care system, including specialty care, hospitals, home health care, and community services and supports. Such coordination is particularly critical during transitions between sites of care, such as when patients are being discharged from the hospital.” While there is an expectation that the primary care physician must be a central figure in coordination of care, ensuring that doctor has all of the information needed may fall to a Geriatric Care Manager (for seniors) or home care agency that is engaged on a daily basis with the patient.
- The Medical Home must make services more accessible to the patient than other delivery models. As the AHRQ says, “The primary care medical home delivers accessible services with shorter waiting times for urgent needs, enhanced in-person hours, around-the-clock telephone or electronic access to a member of the care team, and alternative methods of communication such as email and telephone care.” This again points out the critical role of the care manager, who is unlikely to be the primary care physician. Agencies who develop a specialty in this role will be in demand if this model is to succeed broadly.
- There must be a strong emphasis on safety and quality. Quality health care delivery and a focus on continuous improvement are keys, with “ongoing engagement in activities such as using evidence-based medicine and clinical decision-support tools to guide shared decision making with patients and families, engaging in performance measurement and improvement, measuring and responding to patient experiences and patient satisfaction…” Dr. Steven Fox, of Wellspring Personal Care, and others have shortened this to a very simple statement: No outcomes, no income. If we cannot demonstrate improved results, there should not be any financial reward. At Support For Home Health Care, we strongly endorse this approach.
We will be exploring this model more deeply, as well as other elements of health care reform, in future articles. Let us know what you think.
Thanks and best wishes. Bert