The patient-centered medical home? That's not a new concept to the folks at Chicago-based La Rabida Children's Hospital.
The patient-centered medical home? That’s not a new concept to the folks at Chicago-based La Rabida Children’s Hospital.
“We’ve been doing primary care in this model without the fancy words attached to it for more than 30 years,” says Pam Northrop, LCSW, medical home program manager. “We are the primary care doctor, but the difference is our physicians are specially trained in understanding children with special healthcare needs.”
And that approach has paid off. La Rabida’s medical home program for children with special healthcare needs was selected as a finalist for the 2014 Jackson Healthcare Hospital Charitable Services Awards.
“Our program depends on outside funding, and we’re honored that Jackson Healthcare Hospital Charitable Services Awards recognizes the value of this approach to providing comprehensive primary care to our patients and their families,” Northrop said.
The physicians at La Rabida are specially trained in understanding children with special healthcare needs. For example, if a child has a gastrointestinal tube, that’s not unusual for the staff at La Rabida where a nurse is specially trained in helping and supporting the family if the tube falls out, checking how it’s working, and training the parents.
“We have the resources here to be able to support the family for children with a gastrointestinal tube,” Northrop explains. “Community doctors don’t have those resources. So by nature, we have the whole wrap around structure to be able to support children with special healthcare needs.”
As part of the program, staff works with the local school system to provide children with all of their immunizations and necessary screenings that they would in a traditional primary care setting.
“So, we do what is standard of care in primary care,” Northrop says. “But in addition, because we have training in children with special healthcare needs, we can then provide all the other support for the children. We are providing primary care within a specialty care setting.”
The benefits of the medical home model to patients are clear. The coordination of care, particularly for children with special healthcare needs, is like a life raft in an often-fragmented sea. But the benefits for physicians are tangible as well.
“Functioning as a team always makes anyone feel very supported,” says Edith Chernoff, MD, head medical home physician at La Rabida. “To be able to function where you know that it’s not just you, but there’s a whole safety net around, makes a very big difference and I think makes you feel much more assured.”
Some specialists are beginning to operate their practice as a patient-centered medical home, a model that has been pioneered by primary care doctors. But Chernoff says that, minus the official PCMH designation, many specialists already function as part of a healthcare team.
“There are very few diabetic docs who don’t have a team around them,” she says. “Whether they call it a care manager, or they have nurse practitioners, they’ve been functioning on teams for many years. It’s just that there’s no recognition of it. And for other specialists, I think it’s important for strong communication between the primary care doc and the specialist.”
That means talking to one another, Chernoff says. Physically, verbally speaking to one another.
“Everyone keeps touting the computer system as the be all and end all,” she explains. “But you know, computer systems don’t actually talk to each other. When you want to know whether a child has received medication, sifting through insurance information is really cumbersome, and not current. And most physicians don’t have the support to do that.”
The Physician’s Role
Can the patient-centered medical home model have a bottom line impact on a medical practice? Can it reduce costs while enabling more value-based care? Chernoff says those are 2 different considerations.
“As patients and their families are more engaged in their health care by working with their doctor in a PCMH, following up on such issues as taking their medication and going to specialty appointments, there may be less use of ER and less need for hospitalization, 2 areas where health care dollars are frequently spent,” Chernoff says. “Also, we think that over time the additional care management supports that are part of the medical home will help to impact on cost of medical care. Patients who are better educated on care of their illness and who are more connected to their physician will know the consequences of running out of their medication and how to contact their PCMH to get the prescription renewed. Without the prescription the patient may become sick.”
As for value-based care, she says that holding physicians or medical groups responsible for patients’ health is a more complicated issue.
“I think it’s very dangerous to put everything on the physician,” Chernoff says. “To say the physician is the one who’s going to cause the most change in terms of outcome—diabetes control, weight loss, asthma—I think that’s too much to ask of the doctor. I think there has to be responsibility somewhere on the patient.”
That said, Chernoff does feel that physicians can and should be active participants in terms of working toward those goals.
“I think that when you look at value payments, which is what everyone is doing now, what’s going to happen is now it’s a payment and in 5 years it will be a cost,” she explains. “They will start taking away money from physicians who can’t keep their patients from smoking, or their diabetic patients from not taking their meds, or not losing weight. And it’s not okay to fine physicians for their patients’ lack of compliance.”