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Insiders' Insights: The Medical Home Debate

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The Medical Home Debate

Many tout medical homes as the next great solution in healthcare delivery. But who will deliver and coordinate the care? How will all the pieces fit together in a fragmented care delivery system? Despite models that demonstrate financial savings, some still contend medical homes may not be cost effective.

Ted Epperly, MD
President
American Academy of Family Physicians

People with medical homes have a trusting relationship with their physicians and their medical team. Their doctors coordinate care and make sure they see the right doctor at the right time. The expertise of the primary care physicians who work in patient-centered medical homes isn't limited to a body of knowledge; it's focused on a group of people. The goal in these practices is not to be responsible for patients but to be responsible to patients. The result? Each patient gets comprehensive care with less fragmentation, duplication, and cost. Equally important, medical home programs save money. Community Care of North Carolina saved more than $231 million combined in Medicaid costs in 2005 and 2006, and IBM's patient-centered primary care program has yielded healthcare premiums 6% lower for family coverage and 15% lower for single coverage when compared to industry norms.

Joseph Antos, PhD
Wilson H. Taylor scholar in healthcare and retirement policy at the American Enterprise Institute
Washington, DC

Medical homes are a great idea. We just don't know how to do it. There are a lot of thorny issues. First of all, who is a primary care physician? All sorts of specialists claimed to be primary care physicians when that was popular. We are going to have the same problem with medical homes. We have to define what you want out of a medical home, who is going to provide whatever the services are, and ultimately decide if you're going to pay more for that or make that part of the standard set of services that all primary care doctors provide. As it stands now, where much of medical practice is done in individual doctors' offices without any strong connections to anybody else in the health sector other than a referral, a phone number, and so on, the idea of a medical home seems more like an ideal rather than a practical model.

John Commins

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