Should every person living in the United States have access to a Medical Home?
Many people in the United States do not have access to high quality, point-of-entry primary care. And, there is substantial evidence indicating that sufficient access to high quality primary care results in lower overall health care costs and lower use of higher cost services, such as specialists, emergency room, and inpatient care. In an environment where health costs are growing faster than employee wages and the economy at large, the U.S. health care system is ill-prepared to meet the current and emerging health needs of the population due, in great measure, to the growing prevalence of chronic conditions and lackluster success in managing their progression to more costly acute episodes and long-term care settings. Kaiser data reflect spiraling health insurance premiums for the past twenty years that far outpace overall inflation rates and worker earnings. Health care costs continue to grow faster than overall worker wages and inflation (note the largest gaps in 1989 and 2003), with patients shouldering an increasing share of these costs through higher co-payments and deductibles. There are significant gaps in the quality of healthcare that patients in the United States receive. The current healthcare payment and delivery system is particularly poor at providing care for the people with chronical conditions. As result of these factors, a new model of service delivery that better support the provision of effective, patient-centered primary care is essential. The concept of the medical home has recently received attention as a strategy to improve access to quality health care for more Americans at lower cost. There are also some limitations to medical home including shortage of primary care providers, and reimbursement issue. Should every person living in the United States have access to a Medical Home?
Definition and Description
According to Rosenthal (2008), “a medical home is patient-centered, multifaceted source of personal primary health care” (p.1). A “medical home” is not a house, hospital or other building. Rather, it is a term used to describe a health care model in which individuals use primary care practices as the basis for accessible, continuous, comprehensive and integrated care. The goal of the medical home is to provide a patient with a broad spectrum of care, both preventive and curative, over a period of time and to coordinate all of the care the patient receives. The American College of Physicians stated (as cited in McHugh, Aiken, Cooper, & Miller, 2008) that in medical home, primary care provider coordinates a team approach to patient-centered care in order to enhance access to care through expanded hours and open scheduling as well as emphasis on evidence-based practice and quality outcomes to improve service delivery. The concept of medical home has been promoted by primary care organizations, including the American Board of Family Medicine, as an answer to government agencies seeking political solutions that make quality health care affordable and accessible to every person living in the United States (Rosenthal, 2008). According to Schram (2010), “The Medicare Medical Home Demonstration Project, commonly called the medical home, is a viable alternative for the improvement of care coordination, yet there is no clear consensus of what this practice redesign should look like” (p.132). Two trends are helping to build momentum around the medical home model: 1) a growing shortage of primary care clinicians due to adverse practice conditions; and 2) the increasing prevalence of chronic diseases among the U.S. population. It is important to note, however, that the medical home model is not without controversy. The disease management industry has...