Medical Homes: Collaborative Care
pdf
e-mail
print
Although frontline physicians are likely to be increasingly in demand as aging baby boomers develop chronic illnesses, their numbers are falling. In part, that’s because of the explosion of medical knowledge, which naturally leads to increased specialization. But internists and family practitioners are also retiring in record numbers, and fewer students seem willing to sign on as generalists, who may earn half as much as many specialists while working long hours and facing piles of paperwork. There’s already a primary care shortage in many parts of the country, and it could worsen if health reform provides coverage to tens of millions of uninsured people. “We’re at a tipping point,” says Bruce Landon, an associate professor at Harvard Medical School who is studying medical home pilots. “Something has to change.”
joe fornabaio for proto
Yet hopes are high that the medical home model could be at least part of the solution to out-of-control health spending, as well as addressing concerns about quality. A 2004 study by the Future of Family Medicine Project, a collaboration among seven national family medicine organizations, estimated that total health care costs would decrease almost 6% if medical homes became the norm, saving some $70 billion annually. And one major proponent of the model—the Patient-Centered Primary Care Collaborative, a coalition formed in 2006 by IBM and other businesses that has grown to include more than 700 members, including large employers, insurers, consumer groups and physicians—suggested in a report that the patient-centered medical home, “if appropriately conceived and properly implemented,” could transform the U.S. health care system.
The notion of a medical home has been around for decades. The American Academy of Pediatrics coined the phrase in 1967, initially referring to a central location for archiving a child’s medical record. In 2006 the American College of Physicians expanded the definition to include providing accessible, continuous, comprehensive care—exactly what most physicians found themselves not delivering as they were pushed to see more patients, spending an average of less than 10 minutes on each patient visit.
Other medical associations, such as the American Academy of Family Physicians, have endorsed and developed medical home projects; and along the way, “patient-centered” has been added. Medical home advocates now consider the concept nothing less than a means to reinvent primary care. “There’s a whole literature about how more primary care is associated with things we want to see: lower costs and better quality,” says Landon. For example, public health researcher Barbara Starfield of Johns Hopkins University has found that an increased supply of physicians in primary care is consistently associated with improved outcomes for cancer, heart disease and stroke, and with increased life expectancy. Other research has found that U.S. adults who have a regular primary care physician rather than getting care from a specialist cost a third less to treat.
