Medical Home is About Patients First

When the medical home comes up for discussion, I'm reminded of an old and tired joke about hospitals that is a sly twist on the old saying, "if you've seen one, you've seen them all." Of course, you've all heard it: "If you've seen one hospital, you've seen one hospital."

In other words, they're all remarkably different in culture, how they operate, how they treat patients, what's important to them and how they survive. My story in this month's HealthLeaders magazine looks at least partly into how hospitals make the case to patients for the switch in treatment protocols. But I'm even more intrigued by how health systems and physician practices measure this important metric: How do patients perceive the various medical home philosophies out there?

No two are alike, yet the goal is the same: Get the patient, the patient's family, and the patient's caregivers to participate directly and actively in the success of their care. When you put it that way, it seems like a slam dunk.

Of course, this mostly pertains to those patients who have the most complex conditions and who  require constant monitoring, such as diabetics, those with chronic heart failure, cancer, and innumerable other chronic long-term maladies.

There's not much involvement—or need for involvement—from a medical home perspective for a healthy 22-year-old, for example. The medical home patients that benefit most, and who can benefit most from a cost perspective, are those whose treatment is the complicated and expensive.

Of course, that's one reason the medical home philosophy and regulations were developed, because these patients were too often receiving suboptimal care and or unnecessary care, which increases both suffering and costs. That's a lose/lose proposition if I ever saw one. 

But often, too little time is spent on the way patients view the changes they are expected to make under the medical home organizational philosophy. I was intrigued by the fact that most of the sources with whom I spoke treated the medical home concept not only as an opportunity to reorganize the ways they deliver care, but also to educate patients on why the way their care was changing was better.

That's because on the surface, to the patient who is not privy to all of the technological and organizational revision that is behind how their visit is conducted, it might seem as though they are being shunted off to lower-level employees so the physician doesn't have to spend as much time with them.

In reality, they're getting much more individualized attention—in most cases. It's up to the provider to explain why the new way they're interacting with their physician is preferable.

Instead of showing up unprepared for an appointment likely booked months previous, patients get phone calls, pre-visit planning meetings, lab visits, and the like in preparation for the physician visit so that time is used more productively. 

Physicians no longer need to answer insurance questions or other low-productivity activities because that's all been taken care of prior to the visit. Such pre-visit interactions might involve a social worker, a nurse, a nutritionist, or all three. And with an electronic medical record populated with the latest results, visits with the physician are more productive and offer fresh data for the doctor to review with the patient.

If more people are paying attention to you and your issues, offering real solutions to some of the problems you're experiencing as a patient rather than waiting for the three-month or six-month physician follow-up, aren't you more likely to take an interest in managing your care?

Most of the sources I interviewed for my story feel that's the case. And the early results from their changes in practice are encouraging. Their stories are a reminder that while significant changes need to be made, it's more important than ever for hospitals health systems and physician practices to ensure the message that this is all about better healthcare, is received by the patient, and that it comes through loud and clear.