‚Medical Home‘ Concept Improves Care, Controls Costs

WASHINGTON – Wouldn’t it be fantastic to get the old-fashioned kind of health care, in which the doctor knew you and your family and kept track of your medical condition, but with the additional convenience and access to health care information that modern technology provides?

That’s exactly what the TRICARE health insurance program is striving to provide as it rolls out the new patient-centered „medical home“ concept to an increasing number of its beneficiaries, Navy Rear Adm. (Dr.) Christine S. Hunter, the top TRICARE officer, told American Forces Press Service.

Civilian medicine has embraced the medical home concept, which introduces a team approach to health care and establishes a consistent, long-term relationship between patients and a provider team, Hunter explained.

The TRICARE Management Activity began introducing the concept last year. Already, 655,000 of its 9.5 million beneficiaries are enrolled in the medical home concept. Hunter’s goal is to increase that number to 2 million by the end of 2011. Within the next several years, she said, she hopes to see as many as 3 million beneficiaries in enrolled in the concept. The Air Force was the first service to begin introducing the concept through its Family Health Initiative. The Navy followed with its Medical Home Port. The Army followed with its Army Home for Health program, which focused initially on wounded warriors but now has expanded.

In addition, 750 TRICARE network providers are now certified as medical homes.

In some cases, participation is voluntary, with facilities offering beneficiaries the option to join as medical home teams are stood up. In other cases, entire sites have transformed into medical homes, with all of their beneficiaries assigned to medical care teams.

Regardless of how the concept is introduced, Hunter called it a win-win situation for everyone involved. Patients are assigned to a medical home team that typically consists of a doctor, a physician’s assistant, a nurse and medical technicians. Together, they partner with the patient to support a comprehensive health care plan, Hunter said.

This improves the patient experience, she added, by fixing what many beneficiaries call a shortcoming of TRICARE as well as many other health care programs: never seeing the same health care provider twice.

That too often put patients in the position of having to explain and re-explain the same issue or concerns to every new doctor, Hunter said. As a result, she explained, they were likely to focus only on immediate concerns –- what brought them into the doctor’s office –- instead of long-term health maintenance and wellness goals. Under the medical home concept, every member of the provider team has access to the beneficiary’s medical records, and works collaboratively with the rest of the team to provide the best care possible, she said.

When patients visit a hospital or clinic or call in with a question or concern, they see or talk to a member of that team –- not another health care provider who steps in because the patient’s provider is unavailable. And if the patient needs to be referred to a specialist, the team makes the referral and tracks the results. Ultimately, the patient receives better, comprehensive care and a better overall health care experience, Hunter said.

And because the medical home concept puts heavy emphasis on preventive medicine, it helps to address problems before they escalate, Hunter added. Not only does this make beneficiaries healthier, she said, it also reduces the need for catastrophic and expensive medical intervention.

Meanwhile, the patient-centered medical home concept takes advantage of new electronic tools to further improve communication between patients and their health care teams. Patients can use these technologies to schedule appointments, get prescription refills or have health care questions answered. And if they need to contact a health care provider after normal duty hours, they can do so virtually. That reduces the likelihood that they’ll report to the emergency room because they don’t know where else to go, Hunter said.

The health care team, in turn, can use these technologies to remind patients when it’s time for a checkup, test or inoculation or to deliver lab results and explain what they mean. They also can use them to provide information and coaching to beneficiaries working to lose weight, quit smoking or achieve other longer-term health maintenance or wellness goals. Ultimately, Hunter said, the medical home concept supports what she calls TRICARE’s „quadruple aim.“ „We want to have readiness for the military members and their families, and we want to do that through the best possible health [for beneficiaries] and enhance the patient experience,“ she said. „And then we want to do so at a responsible cost.“ Cost considerations make the concept particularly attractive as Defense Secretary Robert M. Gates seeks ways to control health care costs that are eating away an ever-increasing percentage of the Defense Department budget.

But Hunter said the best part of the patient-centered medical home concept is that it puts beneficiaries‘ interests first. „You are getting quality, you are getting a good patient experience, and then the cost [of delivering health care] will naturally follow,“ she said. „If patients are healthy, the cost is low. … So if you do the right thing for the patient and then we get to health, cost will follow.“

U.S. Department of Defense
Office of the Assistant Secretary of Defense (Public Affairs)

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