In recent years (especially with the advent of the Patient Protection and Affordable Care Act) and new (actually really old) term came back to the forefront of our healthcare system: Patient-Centered Medical Home.
The Patient Centered Medical Home is a health care setting that facilitates partnerships between individual patients, and their personal physicians, and when appropriate, the patient’s family.
The reason that this is a new idea is that as recently as fifty years ago our healthcare was (primarily) managed by family physicians that knew us personally and took care of most of our needs. (We also paid for most of our care out of pocket, but that’s another post.) With increased specialization and insurance reimbursement, however, our healthcare system fractured in to the model we have today: We typically run to a disconnected specialist first before talking to our primary care physician.
HMOs tried (in vain) to reintroduce this hub-and-spoke model but consumers never got comfortable with the idea that someone in a cubicle hundreds (or thousands) of miles away got to decide if they needed a procedure or not. The patient-centered medical home tries to improve this model by placing a primary care physician at the center of the wheel to work with you on the best course of your care.
Supporting this model (or at least it’s supposed to be supporting the model) is a significant amount of technology that enables coordination of care across access points and stakeholders. The problem with much of this technology (especially EHRs) is that they’re not patient-focused at their cores. Too many EHRs (and the practice management systems that wrap them) are built with the payers and providers at their middle instead of the customers they both serve: Patients.
Usability is terrible. Interoperability is virtually non-existent (although it is getting better as the first HITECH incentive payments have started flowing). Providers are in revolt (see the usability comment above). And the patient is locked out of having visibility in to almost any of it.
I love the idea of the patient-centered medical home. I think it’s where healthcare really needs to go. Unless we put the patient at the middle of all of the enablers of the medical home, however, I do not believe we’ll be able to capture all of the possible benefits.
