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The "Medical Home" coordinated care model is rapidly gaining traction, especially in light of  the overarching federal healthcare reform efforts.  The U.S. VA (Department of Veterans Affairs) and DOD (Department of Defense) are particularly interested in the framework as a means to improve primary care for their approximately 16 million beneficiaries.  See link below to excerpts from a recent article published in VA Research Currents ...



Next-generation primary care, coming to a VA clinic near you

Hallmarks of the medical home

Gordon Schectman, MD, acting chief consultant for VA's Office of Patient Care Services, provides the following definition of PCMH on an Intranet forum for VA staff involved
in implementing the model: "A patient-centered medical home is a
team-based model of care led by a personal provider who enables
continuous and coordinated care through a patient's lifetime to maximize
health outcomes. The PCMH practice is responsible for providing for all
of a patient's health care needs or appropriately coordinating care
with other qualified professionals."

Other sources describe the ideal PCMH as one in which clinicians:

  • take personal responsibility for patients' care
  • offer expanded hours, and availability on short notice
  • have email and phone contact with patients to augment visits
  • use the latest technology, including electronic health records
  • provide regular check-ups and offer preventive care based on patients' individual risk factors
  • help patients make healthy lifestyle decisions
  • offer patients the latest evidence-based treatments
  • coordinate care with other providers when needed and ensure that all procedures are relevant and necessaryTransformation already under way
Transformation already under way

A handful of VA clinics began moving to the new model a year or two ago. VA policymakers say at least 80 percent of VA clinics will follow suit by 2012. The rollout is a huge effort—even by VA standards—that is costing some $250 million. It's expected to pay long-term dividends, though, both for patients and the system. Among the core features: team-based care that emphasizes continuity; a bigger role for nurses in coordinating care; email, secure messaging and other alternative forms of contact with patients; and more attention on behavioral health issues. The makeover across all VA sites should be complete by about 2015 ...

.. Medical homes, ideally, feature excellent communication between primary care providers and other pieces of the health care system, such as specialty clinics or home-health services...

... Teamwork is another cornerstone of the medical home. In VA's model, this typically means a physician, nurse practitioner or physician assistant; registered nurse; clinical associate such as a licensed practice nurse or medical assistant; and clerical support person. Such a
team will typically care for up to 1,200 Veterans. Support is provided by a pharmacist, social worker, mental health therapist and dietician, all of whom work closely with the primary team members...

Major study will probe medical home model

Five teams of top VA health-services researchers in five different regions have begun a wide-reaching study of the medical home model. The effort will take three to five years. The teams will address a complex array of issues, drilling down to the details of day-to-day care...

... The medical home concept has been studied outside VA, mainly in small pilot projects, by systems such as Kaiser Permanente and Group Health Cooperative. But no prior research has been on the scale of VA's new initiative...

Demo labs span the nation

... a team in a Midwest VA region that spans parts of Iowa, Minnesota, the Dakotas and Nebraska will explore how the medical home serves rural patients. Four in ten patients in that region live in rural or "highly rural" areas...

...Another demo lab, based in southern California, will home in on care-team structure and processes. The group will also test a telemedicine program for formerly homeless Veterans with chronic physical or mental illness who found housing through VA....

...A third demo lab is based in a mid-Atlantic VA region that spans parts of Pennsylvania and five other states. The network serves a racially and economically diverse mix of Veterans, from inner-city Philadelphia to the farmland of West Virginia....

Move to medical home on par with VA shift to Health IT in 1990s

Parallel to the sweeping changes that transformed VA in the 1990s into a first-rate medical system, the move to the medical home is being seen as the next critical transformation for the nation's largest health care system...

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