How to Cover "Medical Homes" Under Health Reform - Without Being Boring

Published on
September 28, 2010

The "medical home" is one of those elements of health reform that seems like a classic DBI story: dull but important. It doesn't have to be.

In this post, I'll talk about what medical homes are, why is everyone talking about them in the context of health reform and how can you cover this topic in your community in a compelling way.

First, though, check out Julie Rovner's National Public Radio story and Michelle Andrews' Washington Post/Kaiser Health News story on medical homes – each is a great example of journalism that explores what medical homes are and why they're important without descending into wonkery.

Medical homes, sometimes called "patient-centered medical homes," are a model of care that aims to coordinate all primary and preventive care for a patient through a single physician and his or her staff. You might have heard of them for the first time during the contentious national debate over health reform, but the concept has been around for decades. Check out this American Academy of Family Physicians report for a comprehensive overview of the history and elements of the medical home model.  

With a medical home, the thinking goes, a patient's primary care would be coordinated by one doctor or medical practice, potentially saving money by focusing on preventive care, keeping patients out of costly emergency rooms, avoiding duplicated tests and letting paraprofessionals like nurse practitioners do some of the tasks that traditionally fall to doctors. Michelle Andrews puts it nicely in her story:

The medical home model is an approach that harkens back to the days when family doctors were so familiar they almost seemed like part of the family. In today's medical home, a primary-care doctor leads a team responsible for coordinating and managing all of your care, whether it's making sure you're on top of routine lab tests to keep your diabetes in check or being available to handle unexpected problems, even during off hours. That coordination improves patient care and may help control costs, advocates say.

Embracing the medical home model generally requires physicians to retool their entire practices, rethinking how they schedule and communicate with patients, adding electronic medical records to better track patients and incorporating techniques to ensure that treatment is coordinated among primary-care doctors and specialists.

People are paying renewed attention to medical homes because the new health reform law has earmarked money to help health care providers create them and because they may help reduce health care costs. Physicians can receive extra money from private or government insurers to compensate them for providing the coordination of care that's the hallmark of medical homes, but they may need to change the way they practice or keep records to qualify for that extra money. Will doctors view the extra money as enough incentive to make what could be some pretty big changes in the way they do business?

Here's some other context to remember as you report on medical homes: this discussion is taking place against a backdrop of concern that with a flood of newly insured patients, there won't be enough primary care doctors to treat them. Plus, a new Deloitte report finds that while medical home pilot projects could reduce health care costs, some faced opposition from doctors - and patients - resistant to changes the medical homes required.

So, how can you follow what's happening with medical homes in your community and turn those findings into compelling stories?

1. Look for demonstration projects. The Patient Centered Primary Care Collaborative, which promotes the medical home concept, maintains a searchable list of pilot projects nationwide. If there's one near you, how is it doing? How much does it cost? What do participating patients and doctors think? Do patients feel like they're getting better care?

2. Are local doctors or medical groups considering moving to a medical home model? Why or why not? What changes would they have to make to qualify or be accredited as a medical home? What are their fears about this model? Are medical homes regarded as just another health policy fad or something more meaningful?

3. There is any number of grants out there – some via the new health reform law and some that preceded it – for safety net health clinics to become "medical homes" for the poor or uninsured. What are clinics in your community doing? Are they competing with each other for grants or teaming up? Is it easy or hard to qualify? Is the extra money significant, and could it make up for any recent budget cutbacks?

I hope you'll share your own medical home stories and any examples you've seen of good coverage in the comments below.

Reporting Resources:

Joint Principles of the Patient-Centered Medical Home: Issued in 2007, this is a key statement from four medical organizations that spells out what a medical home should be.

Accreditation Association for Ambulatory Health Care: This is the only organization currently offering accreditation for medical homes.

Patient Centered Medical Home Resource Page: This American College of Physicians site offers numerous information resources about medical homes, including demonstration projects.

Patient Centered Primary Care Collaborative: This coalition of major employers, consumer groups, patient quality organizations, health insurers, labor unions, hospitals and clinicians aims to advance the medical home model.

Medical Home 2.0: This Deloitte report evaluates seven medical home projects and finds that while they can save money, doctors and patients were sometimes resistant to the changes required of them.