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Wednesday, May 20, 2009 9:00 AM

Navigating Health Care: What is a Medical Home?

Rand: High-quality health care means getting the right care at the right time. But research shows that it’s not always easy to find high-quality, safe health care. And consumers who have several different health care conditions may have an especially difficult time getting their care coordinated. That’s why some experts say creating a health care team is the way to go to provide high quality and safe care, and to give patients a better experience. Here to talk to us about a model called the patient-centered medical home is AHRQ Director Dr. Carolyn Clancy. Welcome, Dr. Clancy.

Dr. Clancy: Thank you.

Rand: Dr. Clancy, many consumers have heard that term, but aren’t quite sure what it means. What is a medical home?

Dr. Clancy: That’s a really good question because the term has been used in many ways. Also, sometimes people confuse a medical home with institutional care or nursing home care. The most common definition of a patient-centered medical home is a practice in which a group of health professionals provide a type of new, expanded primary care - one that takes a team approach and puts the patient at the center of that team. Medical home teams often include doctors, nurses, pharmacists, physical therapists, social workers, and health educators that work together and use technology to provide coordinated care to their patients.

Rand: So, how is this different from what patients get now in many of their primary care settings?

Dr. Clancy: The patient-centered medical home model is designed to give consumers the primary care they need, while at the same time coordinating any other care that they might need. This can greatly improve their experiences and the results of their care. For example, say you need to be seen by a specialist such as a cardiologist. In a medical home setting, your team will help you find that specialist, set up your appointment, and then get you the information you need to be prepared for the visit. Then, the medical home team will also make sure you understand the recommendations of the cardiologist, and what your options are for next steps. A medical home team provides continuity of care and good communication to make sure that you get the best results from your care.

Rand: Is this medical home concept new?

Dr. Clancy: Well, the term "medical home" isn’t new. The American Academy of Pediatrics introduced the term "medical home" in 1967. They were mostly interested in providing better care to children with very complex medical conditions with special needs. Recently, other primary care groups have begun to use the term "medical home" to describe the collaborative, patient-centered approach they had with patients and their patients’ families. So my point is that the term has been around for a little while, but the concept has evolved into how we use it today.

Rand: And where are we today? Is there one group that seems to be leading the way?

Dr. Clancy: The primary care groups including the American College of Physicians, the American Academy of Family Physicians, and the American Academy of Pediatrics, and American Osteopathic Association have developed really great models describing how medical homes should operate. And it’s also certainly worth mentioning that the Centers for Medicare and Medicaid Services will launch a patient-centered medical home demonstration project later this summer. This three-year study will be one of the largest federal demonstrations about medical homes to date and it will evaluate the impact that the medical home model has on Medicare beneficiaries with chronic or prolonged illnesses. The outcomes of this project will be particularly interesting for our aging population.

Rand: Speaking of evolving ideas, earlier you mentioned that technology plays a role in patient-centered medical homes. How?

Dr. Clancy: Well, there are many types of technology that could be used in the patient-centered medical home, just as health information technology is being used more and more in many health care settings today to improve not only the way clinicians work together but also the way patients can access their health care team. For example, in the concept of a medical home, it would not be unusual for a consumer to stay in touch with their health care team, follow up on test results and ask questions through secure e-mail and telephone. Some practices would even allow patients to see the appointment calendars of their health care team and book their own appointments online.

Rand: That sounds like a great idea. The question that many consumers probably have at this point is, "Where can I go to find a patient-centered medical home?"

Dr. Clancy: Great question! So the bottom line is, the patient-centered medical home model is spreading, but you may not be able to find them everywhere yet. However, as a consumer, you get what you’re looking for in your health care by taking an active role. I strongly encourage consumers to go to their clinicians and say, "I want to be an active partner on my health care team. How can we work together to make this happen?"

Rand: Dr. Clancy, thank you so much for joining us to share this great information about patient-centered medical homes.

Dr. Clancy: My pleasure.

Rand: AHRQ has other resources for consumers, including the "Guide to Health Care Quality - How to Know it When You See it," and it’s available for free online at ahrq.gov/consumer.

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