By Scott Shreeve

The September/October issue of Health Affairs is dedicated to reviewing concepts of the medical home. It is most likely the most current, authoritative, and impressive review of this emerging idea. Health Affairs is an excellent resource for health policy wonks to gather, but in recent years has become more accessible to the general health care audience. I would recommend it as required reading for anyone interested in learning about this trend.

Simultaneously, there have been some recently updated “state of the industry” reports coming out of the retail health clinic world. As noted by Jane Sarasohn-Kahn, the fact that more and more retail clinics are being created has increased access, improved quality through an evidence based approach to a limited set of clinical conditions, but has not done nothing to address the cost issue. In fact, increasing the supply of retail clinics, has simultaneously increased the demand for these services. This is a common phenomenon within healthcare, and the supply driven demand has been well described particularly in the hospital setting.

These results indicate that we cannot just solve two parts of the triumvirate – we need to evaluate all three axis’s (access, cost, and quality) in driving toward a workable, long-term solution. I believe, for this reason, that the “Medical Home” has merit. It presents a working model to increase access to a group of patients, ensure that the highest quality of care is practiced, and now there is emerging evidence that this type of practice can also deliver lower cost of care. A primary reason for this appears to be that practice delivery style builds in prevention, early detection, and consultative approach to health care decision making – something that the soul less “gatekeeper” HMO mentality could and would never get right.

I still dislike the name – Health Affairs snarky article titles like “Medical Home or Motel 6” and “A House is not a Home” seems to imply their disdain as well. But there is a growing consensus about the potential impact given the over-arching principles. Regardless of semantics, it is an area rich for continued innovation, development, and exploration.

In the modified words of Herbert Hoover, “New discoveries in [health care delivery models] will continue to create a thousand new frontiers for those who still would adventure.” The race to discovery is on!

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