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What It Takes to Be a Medical Home

The medical home is by now widely recognized as a promising approach to delivering comprehensive care and ensuring the best outcomes for patients. Physician practices and clinics that provide a "patient-centered" medical home deliver primary care that includes around-the-clock access to primary and specialty care, as well as physician and patient access to electronic health records.

Findings from a recent study published in Health Affairs provide evidence that this model of care can improve quality of services and reduce costs. According to first-year results from pilot-test sites, Geisinger Health System in Pennsylvania—which has adopted the model—has managed to reduce hospital admissions by 20 percent and save 7 percent in total medical costs. The article, co-written by Commonwealth Fund president Karen Davis with Geisinger's chief technology and innovation officer, Ronald Paulus, M.D., and its president and CEO, Glenn Steele, M.D., also describes Geisinger's efforts to redesign its care delivery infrastructure and create incentives aligned to enhanced value in health care delivery.

In general, physician practices have been slow to adopt components of the patient-centered medical home. Fund-supported researchers led by Diane Rittenhouse, M.D., M.P.H., at the UCSF School of Medicine reported in the same issue of Health Affairs that the largest medical groups (those with more than 140 physicians), and those owned by a hospital or HMO, tended to score highest on critical medical home measures. "The medical home model holds great promise for the transformation of primary care, but this transformation won't happen overnight," says Rittenhouse.

The Urban Institute's Robert Berenson, M.D., believes medical homes could address some of the seemingly intractable problems plaguing the health care system. But implementing and operating patient-centered medical homes, he argues, require both management capability and physician leadership, as well as the capacity to develop processes and information technology systems. These conditions, he notes, will present challenges for any practice, regardless of size.

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