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Locating the “Medical Home”

There’s no doubt that people — especially those with (multiple)
chronic conditions — need a more holistic model for managing their
health needs than what our delivery system currently offers. The PCMH
model is intriguing, but I have worried that many examples of PCMH
deployment thus far have been centered around the physician’s office
(and, to some extent, the physician’s needs).

In contrast, most patients with health problems are living 24/7 with
whatever is affecting their quality of life, and not much of it is
spent in the doctor’s office. Think about it: There are 8,760 hours in
a year, and how many of them are spent in a health care facility?
Unless someone has multiple hospitalizations in a given year, the
answer is probably far less than 1 percent.

I’ve been fascinated for a long time now by the potential of Ix and
Health 2.0 strategies to deliver to us more robust models of truly
patient-centered medical homes than we have seen in most of the
country. Thankfully, other (smarter) people have also been thinking
about this and were able to join us to present in a recent webinar.

Joe Kvedar from Partners’ Center for Connected Health recently wrote with David Kibbe a terrific piece in The Health Care Blog titled, “The Connected Medical Home: Health 2.0 Says ‘Hello’ to the Medical Home Model."
That kind of home could meet the needs of a lot of people:
“…web-comfortable consumers want a ‘participatory medicine’ experience
with their health care professionals that involves modern forms of
communication and coaching. They want to be ‘connected’ online with
their doctors and nurses, and they prefer having their health
information searches guided, if not filtered, by their personal doctors
and medical homes.”

We also had a provocative presentation from Healthwise CEO Don Kemper, who along with Leslie Kelly Hall, recently wrote a white paper on “The Virtual Health Home.”
In their words, “The virtual health home works from the patient’s
perspective, not only to coordinate medical providers but also to
balance health care services with the many other factors that
contribute to improved health.”

Alan Glaseroff, a practicing family physician who helps run Northern California’s Humboldt IPA and also has been living with Type 1 diabetes himself for 25 years,
provided a unique perspective as well. He noted that the advice of his
own patients has been the most valuable information he receives and his
clinical focus over the years has been on self-management and the power
of peers.

A successful medical home needs to take into account all of these
things in order to provide an effective coordination of people’s health
needs. Future PCMH initiatives should consider a variety of virtual and
physical models for centering care and health.

Joshua Seidman is the president of of the Center for Information Therapy
that aims to provide the timely prescription and availability of
evidence-based health information to meet individuals’ specific needs
and support sound decision making.

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MTMJoshua SeidmanMichael Segal MD PhD Recent comment authors
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MTM
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MTM

The Medical Home is a terrific concept, but the keys to effective, wide spread implementation are well organized primary care physician groups, and appropriately aligned reimbursement systems. As your submission indicates, the main goal of the Medical Home is to provide coordinated services across the continuum in order to better manage chronically ill patients. In fee for service medicine, however, providers are not paid or incentivized to provide care in the gaps that exist as patients are transferred from hospitals, to SNFs, to doctor’s offices, and other care settings. Even in home health Medicare pays for only 60 days of… Read more »

Joshua Seidman
Guest

Michael,
The adviser and shopper roles are two of the many roles that need to be filled by somebody or something in a future health home. Part of what we’re going to explore at the first-ever “Health 2.0 Meets Information Therapy” conference (http://health2con.com/) in April is how both human and artificial navigational resources can help people find their way through both the health care delivery system and wade through information (see Great Debate #4 in our agenda link).
Josh

Michael Segal MD PhD
Guest

A few of us have done some collaborative communication of this type with patients on patient support group listservs, as described in its early phase at http://www.aan.com/news/?event=read&article_id=5277. That model is not directly scalable because part of the patient-doctor collaboration was focused around finding genes for several diseases, but it is hugely valued by the patients. There is an important role for a health adviser who is independent of one’s doctors, insurance company and employer. Such a person could act as a combination of adviser and personal shopper, but since they have no reason to overspend or underspend they could offer… Read more »