As medical homes -- networks of collaborating health care providers -- grow in popularity across the country, the movement will inevitably face challenges, according to an analysis by Elliot Fisher, professor of community and family medicine at Dartmouth Medical School.
The medical-home movement aims to provide better-quality health care at a lower cost by providing patients with an integrated network of physicians who work together with a long-term goal of improving patients' health, rather than merely treating acute symptoms. Medical homes are networks, not physical structures.
"The idea behind medical homes is a potentially great step forward in providing quality health care for Americans," Fisher said. An article on Fisher's analysis was published in the October issue of the New England Journal of Medicine.
The movement aims to restructure the existing system of fee-for-service insurance reimbursements to reflect patients' long term health and satisfaction with care. Medical homes are also designed to improve communication both between patients and doctors, and among health-care providers.
Proponents of medical homes believe the networks will lower overall health-care costs because expensive emergency care for chronic conditions would be increasingly replaced by cheaper and more preventative measures. Few patients are currently enrolled in medical-home programs since the system is currently being tested and implemented by insurance providers, including CIGNA, which recently launched a pilot program with Dartmouth-Hitchcock Medical Center.
The medical-home approach faces significant hurdles, Fisher said. While medical practices are currently encouraged to keep electronic records, there is no system in place to allow physicians to access information held by other practices, a critical component of medical homes.
Additionally, patients may perceive that a medical home is analogous to a nursing home, which may dissuade them from participating.
Another challenge is that under the current reimbursement system, specialists have "no incentive" to adopt the goals of the medical home system since seeing fewer patients with chronic conditions would eventually reduce their own incomes. Also, general physicians have little incentive to collaborate with physicians from other practices in decision making.
Fisher believes there are solutions to these issues. Medical care providers should be required to share patient information, he said, and networks of providers should be enhanced, which would improve communication.
Performance measures should also be revised to reflect longterm patient health, patient satisfaction and overall cost, which would give providers an incentive to collaborate and provide greater transparency to patients, Fisher explained.
He also recommends that the payment system within medical-home systems be integrated to reward longterm savings and improved outcomes, which would give providers a further incentive to collaborate.
Fisher is also the director of Dartmouth's Center for Health Policy Research, and a senior associate at the VA Outcomes Group, a group of physician researchers based in White River Junction., Vt.