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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