A Medical Home: So New It’s Old

by Joanna Smith on Jul 2, 2009

One of my new clients wistfully said the other day, “I wish there was someone at UCSF (University of California, San Francisco Medical Center) who was in charge of me: someone who knows me and refers me to specialists when I need it and then talks to those specialists about what they found out.”

This client was expressing a feeling often voiced by my clients: there is “no one there” to look after them, no one who is looking at the big picture. In fact, this is a common complaint of clients being treated at major medical centers:  who is in charge of all my care?  What he realized in the subsequent discussion was that Healthcare Liaison creates that system for him, and that he had found his “Medical Home”.  A good healthcare advocate does exactly that:  in a complex medical world, we create the “Medical Home”.

The concept of “Medical Home” is not a new concept.  In the era of medicine that pre-dated the rise of specialty practices, there was a medical home with the family doctor.  If someone needed to see a specialist, the family doctor referred them and was in close communication with that specialist and continued to provide the overall care. If you asked someone “who’s your doctor?”, they could easily answer that question.

With the rise in specialty practices, the picture became less clear.  You could go see a specialist for a particular problem, but maybe that specialist was outside of the regular group practice that you used.  Would the information from the specialist get back to your primary care (“regular”) doctor?

With Medical Home, we go back to the original design:  there would be a primary care physician (and office) that would effectively manage a person’s care, contacting specialists, getting updates and keeping the big picture in place.While the concept is very appealing, there are some major structural changes that would need to happen in physician’s practices to make this an effective practice:
1.  The standard primary care physician will not have the time him or herself–and it will not be cost effective–to do all of the  follow-up that needs to happen; the office will need to hire nurses or medical social workers to accomplish this–and that will be costly.
2. Finding qualified personnel to do this kind of care will be difficult:  there is currently a shortage of both nurses and medical social workers;
3. The question of whether insurance will reimburse for these services has yet to be decided;
5. The electronic medical records systems are not yet sophisticated enough for all primary care physicians and specialists to be able to communicate seamlessly with each other.

As a concept of providing care, Medical Home is exciting–and so new, it’s old!

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