House Doc, of Housedoc, say(s):
September 17, 2009

To function efficiently, a Medical Home needs to improve on the current communication channels between physicians and patients. Despite the increased of volume of communications, patients, tests, etc, we still rely on the phone and office visits to exchange informrmation. Opening up online communication channels, such as those provided by services such as housedoc.us, will improve the flow of information, resulting in better patient care and relations.

Josh Davis, of Platinum Select, say(s):
July 23, 2009

I agree 100 percent that the medical home is a fantastic idea...but only if the patients use the advice that the providers has given the. With the billions Obama is planning on pumping into healthcare, there have to be many opportunities to create small business which in turn would create jobs.

Chris Koller, of State of RI, say(s):
April 2, 2009

Melinda and Karen,

Thank you for the summary and ongoing work. As we work with the PCMH in RI, it has become apparent that more thinking has to be done on how we attribute patients to a medical home. Efforts at payment, performance measurement and project evaluation depend on this. In theory it makes sense to rely on a patient committing to a medical site.

However, many of the healthy 80 percent of us are infrequent users and hard to intercept. More significantly, because so much financial data for evaluation can come from health plans and physicians are not always current with insurance responsibility information, health plans have to be involved in the selection process. This can raise patient concerns about managed care and gatekeeper plans. Regardless, more has to be learned about how patients can and should affirmatively commit to a medical home and the responsibilities it entails.

Sonya Glavin, of Family Nurse Practitioner, Duke Health System, say(s):
March 30, 2009

Medical home concepts are not new, particularly to nurses. The care management, coordination or care, and self-management support goals are the basis of nursing science. Unfortunately, no nurse practitioners are included in the discussion. The patient needs a personal primary care provider, not a physician. Nurse practitioner-run clinics are scoring higher than most physician-run clinics using NCQA criteria, but cannot be certified. The new administration and true health care advocates must include nurse practitioners and avoid the reimbursement mistakes of the 90's.

Gary Dewhirst, of North Dakota Board of Pharmacy, say(s):
March 29, 2009

I do think that Medical Homes is a good concept...but where does phamacy play a part? I am a pharmacist in a small community pharmacy in North Dakota. All too often I have a patient discharged from a medical facility with a handful of prescriptions and no other information. I then ask for a copy of their discharge and compare it with the prescriptions that they have in-hand only to find that the prescriptions do correlate with the discharge from the facility. Twenty years ago I shook up our State Pharmacy Association by asking that the hospital pharmacist discharge the patient to his or her community pharmacist, therefore ending the guess work and countless phone calls to verify patient care. Who better to know the patients' current medical profile than the pharmacist?

Kenneth Thompson, of Center for Mental Health Services, say(s):
March 27, 2009

A query: The NCQA criteria--"written standards for patient access and patient communication; use of data to show they are meeting this standard; use of paper-based or electronic charting tools to organize clinical information; use of data to identify patients with important diagnoses and conditions; adoption and implementation of evidence-based guidelines for three conditions; active support of patient self-management; tracking system to test and identify abnormal results; tracking referrals with paper-based or electronic system;
measurement of clinical and/or service performance by physician or across a practice; and reporting performance across the practice or by physician"--do not seem to specifically refer to primary care. Any specialist could also do these things.

It would also seem that a primary care medical home would specify how it relates to other members of the health care team, from health promotion through specialty care through rehabilitation, etc. But I see no evidence of this. What am I missing?

C. Gresham Bayne, M.D., of American Academy of Home Care Physicians, say(s):
March 27, 2009

The attractiveness of the medical home concept becomes even more cost-effective when physician housecalls are added into the care coordination services. The top 5% tranche of Medicare patients consume almost half the budget, and these are the very patients with 5 or more comorbidities who often are forced to use the emergency room doctor as their primary care physician. Patients with 5+ comorbidities are 100 times as likely to have a preventable hospital admission and typically see 14 unique doctors a year in 37 encounters with 49 often-conflicting prescriptions....all in an attempt to manage their multiple infirmities, which preclude easy access in the office setting. As an emergency physician who has participated in a housecall medical group, with 300,000 visits providing lab, X-ray, procedures, etc. in the home, I support the medical home concept strongly, because it will quickly convince my office-peers that getting in their car with the new high-tech black bag is the most cost-effective thing they can do for a select minority of complex patients.