It’s almost – but not quite – a house call.
A new healthcare concept called “medical home” is emerging across the country, especially in Illinois. It is primary care devoted to prevention and to helping people with chronic conditions such as diabetes or arthritis manage their illness. In a medical home, a physician oversees a team of nurses, physicians’ assistants and health coaches who make certain that their patients get the care, support and education they need. Another benefit is that the plan frees up the doctor’s time to focus on the more serious medical issues.
Medicare recently announced a similar initiative, and healthcare reform legislation could champion medical homes. One pioneer in the field is Group Health Cooperative, a Seattle-based HMO that plans to convert 26 clinics in Washington and Idaho to medical homes. The pilot program, established two years ago, reduced ER visits by 29 percent and hospitalizations by 11 percent while improving the quality of care, according to a report in the September issue of the American Journal of Managed Care.
For medical homes to function properly, physician compensation will have to change, says Dr. David Swieskowski, chief executive of the Des Moines-based Mercy Clinics, Inc. The model works optimally when physicians are full-time, salaried employees. This payment arrangement is fairly rare, and insurance companies don’t reimburse physicians for taking extra time to talk to patients.
Medicaid introduced a version of medical homes in Illinois through Medicaid in 2006 and 2007. During that time, Medicaid assigned 1.9 million people to physicians who agreed to coordinate care for an extra monthly fee. As a result, immunizations, vision screenings and other types of basic care have improved, state officials say.
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