The medical home model of health care is based on patient-centered coordinated care and management. The concept was developed in the 1960s and initially intended for improving the health of children. However, as the benefits of medical homes became apparent, the model has been extended to serve all age groups.
Unlike what the name suggests, a medical home is not a residential facility. Rather it is a medical facility that provides coordinated acute, chronic, and preventative health care services “under one roof” - with an emphasis on preventative care. Patients attending medical homes are provided with team-based health care; which, although organized by the primary care physician, can involve dozens of medical professionals depending on the patient’s condition.
Unlike traditional fee-for-service physician’s surgeries, hospital emergency departments, and urgent care centers - which generally provide problem-focused care - medical homes provide patient-centered care which involves the patient in the decision-making process. The provision of care can be face-to-face, but increasing use is being made of technologies such as telemedicine in order to make the medical home model more accessible.
The Benefits of Medical Homes
Several studies have been carried out to determine the benefits of medical homes. One of the first was in 2010 when the Patient-Centered Primary Care Collaborative conducted a state-by-state review of pilot and demonstration projects. The organization’s research found reductions in ER visits varied from 15 percent to 50 percent, hospital admissions fell by between 10 percent and 24 percent, and - due to the fewer acute services required - costs were reduced by up to 26 percent.
In 2016, the National Committee for Quality Assurance (NCQA) produced a summary of research conducted since 2010 showing similar results across eighteen studies, while a comparison of patients treated in medical homes vs. non-medical homes published by RTI Press found a 20 percent better rate of patient outcomes in medical homes and savings of 10 percent. It has also been claimed staff burn out in fee-for-service practices three times faster than in medical homes.
Patients Have Responsibilities to Uphold
The benefits of medical homes are not solely attributable to the treatment model. Patients are expected to engage and interact with their primary physician and the supporting team, and be responsible for carrying out recommendations made by the team to support continuous and coordinated care - even if this involves lifestyle changes. Some medical insurance providers insist on this level of cooperation before providing coverage for medical home treatment.
It is also important patients keep care teams informed when they undergo treatments outside the medical home - for example if they have a flu shot at a retail outlet or are admitted to hospital while on vacation. Some medical home groups have health information exchanges for events of this nature, while others provide patient portals that patients can log into and update their profiles with treatments they have received from third-party sources.
The Number of Medical Homes is Growing Fast
At the time the Patient-Centered Primary Care Collaborative conducted its state-by-state review in 2010, there were twenty-seven projects underway. By 2017, more than fourteen thousand primary care practices had achieved medical home accreditation according to a report by Milliman. The report´s authors noted it was becoming more financially viable for fee-for-service practices to change their operating model due to state and payer incentives. Other observations included:
- Improved reputations for providing high quality care
- Increased patient adherence to care plans
- Fewer number of appointment no shows
- Reduced medical liability insurance
The Milliman report concluded the medical home model has transformed primary care. While patients have benefitted from higher quality care and better outcomes, accredited medical homes have become more efficient and reduced costs. Naturally fee-for-service practices have to consider whether the initial investment required to change the business model will generate sufficient return to be worthwhile, but it certainly does seem the medical home model of healthcare is the model for the future.
Staffing Shortages in Medical Homes
There is a large shortage of nursing professionals in healthcare, which impacts the professionals working within medical homes as well. The nationwide shortage is expected to increase and reach epidemic levels in the coming years, which will negatively affect nurses and medical professionals. Increased stress, staff burn out, lack of proper sleep, and work-related injuries are just a few of the burden’s nurses face with staffing shortages. With the staffing shortage only expected to get worse, preparing in advance could be extremely beneficial.
Could your medical home use technology to fill last-minute callouts, automatically inform your nurses when a shift is filled, and offer more staffing assistance during daily operations? Learn more in our eBook.
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