Private Practice Insights: Medical Homes

By Stuart A. Bussey, M.D., J.D., UAPD President

My old UCI family practice attending doc recently spoke at our Departmental meeting.  He set out six standards for the new patient centered medical homes—enhanced access, management of patient population rather than individual patients, planning care, increased self care, coordination of care and measurement of performance.  As information systems spread, he reasoned, office based medicine can be transformed from episodic, reactive care to more proactive and continuous care.  Both individuals and groups of patients can be addressed in this model.  More flexible emails and texts increasingly replace telephone calls as a means of communicating with my patients. This asynchronous communication may seem impersonal but can be effective, especially for questions after hours.

Chronic disease can be more easily managed by practice teams in the new home model.  In more traditional practices, diseases like hypertension and diabetes can expect to reach outcome target values 25-40% of the time.   But in large medical homes such as Group Health or Kaiser that target percentage is set at 80%.  In addition, patients can become more involved with their own care.  For instance, Kaiser patients can schedule their own mammograms and lab tests.

“Peer mentoring” is another example of an out-of-the-box strategy.  One such example is offered by Wellmed Management of San Antonio. The program involves 50 recruited and trained diabetic mentors and mentees.  The mentees attended a series of twelve 3 hour peer led workshops on diabetic self management.  After six months the mentored patients had better statistical outcomes compared to a control group.  For instance, Hemoglobin A1C dipped from an average of 6.34 to 6.13.  The mentored patients also increased the number of times they checked their own blood sugars compared to the other group.