Keeping the focus on patients
Team-based care, increased access add to a better medical home, panelists say
Editor’s note: The following is an edited excerpt of the transcript of a June 22 editorial webcast, “Building a Better Medical Home” conducted by Modern Healthcare. The panelists were Dr. Karen DeSalvo, commissioner of health for the city of New Orleans; Dr. Jim King, medical director of Prime Care Medical Center in Selmer, Tenn., and former president and chairman of the American Academy of Family Physicians; and Dr. Somava Stout, vice president of patientcentered medical home development at the Cambridge (Mass.) Health Alliance. Modern Healthcare reporter Andis Robeznieks moderated the webcast. The webcast was sponsored by Elsevier Gold Standard.
Andis Robeznieks: I had heard some criticism that the patient-centered medical home is really in fact a physician-centered medical home. Can you describe how perhaps some practices go astray in this manner, and can others avoid this pitfall?
Dr. Somava Stout: I think that the idea of a patient-centered medical home initially grew of pediatrics, which actually is where the model is about how you improve care for pediatric patients with chronic pediatric diseases. And then it became a primary-care workforce issue, as we saw providers weren’t—since primarycare providers weren’t sustainable in their practice. And I think the conversation sort of became reframed about how to help primarycare providers stay in practice. What we found is it needs to be about both, and fundamentally having the focus be about patients and about creating—thinking about it as creating sort of sustainable human infrastructure, sustainable teams that are sharing the care of those patients, and empowering the entire team to not just see themselves as being assistants to the physicians, but as being empowered to provide care in a meaningful way to patients has, I think, it’s been a huge—it’s a very different message when you say it that way. But we found that we have to like that way too. So that means the information and medical knowledge that medical assistants or front-desk members bring, which we eventually found to be priceless.
Robeznieks: I have heard stories too that the increased access that you talk about and the fast- tracking of patients, some patients misinterpret that as, you know, they’re used to the long waits, and then when they can see a doctor right away they think, ‘Well, maybe the practice is in trouble and that’s why they can get in so quickly.’ And I was just wondering if there were any other aspects of the medical home that perhaps patients misinterpret or don’t feel comfortable with right away?
Dr. Jim King: I’ve really not heard anything negative in any of the changes that we’ve had in our own practice. Of course, I’m in a rural town, so everyone knows me and knows my partners as well, so they know that we’re trying to make this change to add more services to them. And it is amazing. You know, I gave the story of our fast-track program. I’ve honestly had patients’ mothers who’ve come in and almost were in tears thanking us because, you know, they have two other kids to take care of, and just knowing that we saw them at their time—we have tried to show that we care about their time is just as important as our time is a very important aspect that the patients appreciates. They appreciate us worrying about their health instead of just trying to solve a problem every once in awhile. Family medicine is one of the greatest things in the world. We’re one of the few groups that get to meet with our friends all day and maybe, just maybe, have a positive impact on them.
Robeznieks: Does a medical home have to be primary-care centered or does a specialist have a role?
Dr. Karen DeSalvo: The specialists have a role in patient-centered medical home and particularly, as we’ve learned from the pediatrics world, that they’ve been successful in using that framework to develop specialty-focused medical homes for kids with major chronic issues. I think in adult populations, if you think about individuals on dialysis, cancer patients, heartfailure patients, it’s clear actually that some of those specialties have already created teambased care in that kind of approach. So, there are already models that exist in the wild I’ll call it, and so absolutely this—what this gets down to for us in Louisiana is that it is a structure for good patient-centered care that’s using evidence-based protocols, that’s using evidencebased thinking, population-based approach, high accessibility and a team to wrap around patients and populations. We have too long marginalized that as a part of overall health. It makes it clunky to build and pay for in primary care, but there are some models—not only in Louisiana but in other big institutions like Kaiser and the VA—that are trying to bridge those two worlds financially and structurally so that patients don’t have to have a gap in those services, that those handoffs are warm handoffs that happen in a more invisible way and in a more patient-centered way than they have historically.