Health care costs are out of control, care is inefficient and fragmented, and a recent study found that only 39 percent of Americans are confident that they can get safe, effective care when they need it.
Enter: patient-centered medical homes.
Medical homes are not buildings or hospitals, but a different way of practicing medicine. A patient-centered medical home let patients take an active role in their own health care, by working closely with their primary care physician throughout their treatment. Doctors coordinate patients' health status, manage chronic conditions, track all medications and practice ongoing health management to keep patients healthy and prevent complications.
Proponents argue that medical homes can reduce health-care spending, improve health status, support disease management and prevention, reduce medical errors and reduce racial and ethnic health disparities.
Still, medical home implementation faces some significant barriers. Coordinating care among providers, a cornerstone of the concept, is very difficult without electronic health records and structures to share health information among providers.
According to the
New England Journal of Medicine, only 13 percent of US physicians have even a basic electronic medical record system, but the federal stimulus package includes significant resources for health information technology. Care coordination also requires the cooperation of providers outside the medical home, who would not be reimbursed for that work.
But coordination of care can reduce duplicate tests and prevent errors in conflicting treatment when patients have several doctors. Medical homes have become an important theme in health reform discussions at the federal level.
More states are recognizing the potential of the medical home model. Eight states have defined the concept in law or regulation and seven states are developing processes and criteria to recognize medical homes. Medical home pilots and programs are operating across the country including New York, Connecticut, Maine, New Hampshire, Pennsylvania, Rhode Island, Vermont, and Massachusetts.
The Eastern Canadian Provinces are also adopting the concept. In 2005, Ontario implemented the first wave of Family Health Teams, very similar to medical homes, to reduce emergency room use and expand access to preventive care. There are now 150 Family Health Teams across the province in areas of need, with 50 more in planning.
Treatment in medical homes focuses on prevention and management of disease. Patients are not responsible for keeping track of the details of their care across all their providers such as test results or medication dosages; their medical home coordinates those records.
Medical home patients take responsibility for educating themselves and managing their care, with help from the medical home team. They must learn about their disease, the best ways to maintain their health, communicate openly with their team of providers, and actively participate in their care.
Originally envisioned by pediatricians to serve medically complex children, the medical home concept has been extended to all consumers.
The American Academy of Family Physicians, the American Academy of Pediatricians, the American College of Physicians, the American Osteopathic Associations and the American Medical Association have all signed onto a set of joint principles describing and committing to the patient-centered medical home concept.
Recognizing the benefit to payers, the Patient-Centered Primary Care Collaborative was created by a group of Fortune 100 companies three years ago and is working to disseminate the medical home model. The National Committee on Quality Assurance now certifies practices that serve as medical homes, drawing higher reimbursement rates from many insurers. Medicare is sponsoring medical home pilots across eight states this year.
Patients have different responsibilities and rights within a medical home including directing all care through their provider team; some may associate this with gatekeeping which was not popular in managed care and has largely been abandoned. Proposals to increase resources for primary care and medical homes at the expense of other providers have met strong lobbying resistance. And while there is ample evidence on the benefits of access to a usual source of continuous care, and medical homes are expected to deliver significant savings and improve quality, they have yet to be evaluated. Preliminary research is promising, but more needs to be done.
The patient-centered medical home has great potential to re-orient our health care system toward prevention and management of disease and away from incentives for over-treatment. Medical homes are gaining acceptance as a way to reduce health care costs, improve quality, and eliminate inequities in our health care system.
Dr. Ellen Andrews is CSG/ERC's Health Policy Analyst. She can be reached at eandrews@csg.org. CSG/ERC'S Health Policy Steering Committee helps regional policymakers identify common health goals, find realistic solutions and implement innovations to improve the region's health. 
