(Ed. Note: We use “reform” when the payment is the issue. We use re-form when how care is organized is the issue. In our opinion, they cannot be separated and get a successful plan.)

What do you want from your doctors?

Today, a great many people worry first about being able to pay for their care.

They also want to be satisfied. There are many different satisfaction measurements taken. To a greater or lesser degree, depending upon whose survey you read, many more Americans report themselves somewhat satisfied to satisfied than don’t.

What does the word “satisfied” actually mean?

We would see “very satisfieds” all over America if each patient had a primary care medical home.

We would see “very satisfieds” all over America as payers could calculate the benefits of dollars spent or saved.

Medical home, as the column by The New York Times’ Jane Brody, explains below, does not mean a return to house calls made by doctors. It does not mean putting us in homes, either, let me quickly add.

Instead, the “medical home” term means that a family has a team of professionals caring for them and coordinating their care.

The emphasis here is on family care but it need not be only for families.

Let me add that this approach can work as well for a single person whose doctor is a general internal medicine specialist (internist).  Since the idea of medical home came from pediatricians, also specialists, this is a concept that can work for patients of all ages, marital status or complexity.

Good primary care is key to getting the full benefits of all care provided to patients, regardless of specialty.

A good primary care doctor is the one who knows the patient’s whole story. The one a patient turns to when no diagnosis can be found and specialists are needed. The one a patient turns to for reassurance or support at tough times. The doctor who can make it clear what the treatment plan is, why it will help and how the patient can follow it. That’s good primary care.

A primary care team would be even better.

In a demonstration project, paid for by Medicare and Medicaid, writes Brody, one family whose members have assorted medical problems are watched over and participate in their care as every good doctor only dreams of.

I have watched this team approach work as early as the 1970s, when a grand experiment much like the Duke one was tried, and when friends or family members needed a specialty team approach, comparable to the medical home, but for one diagnosis or one procedure.

There are very few things anyone can all but guarantee the American people: If we had enough of these front-line health care professionals—in medical homes—our care safety and quality could improve and quickly; the improvement in best outcomes possible for that patient would speak for themselves; and the questions about the dollar value for care services would be obvious to payers.

Nothing is magic.  As we have noted, we already have a primary care physician shortage. We have had an acute nursing shortage, temporarily eased by a tough recession but which will reappear when better times arrive. It takes time to put together care teams which work smoothly.

That said, it also takes time to have a broken system. Much more time. Much more money, wasted.

There is hope in that this is a Medicare-Medicaid funded project, which means the U.S. government will pay attention.

Duke is a prominent academic medical center, which knows how to get the word out when it has found something new and worthwhile.

In the meantime, read Brody’s column.

You will understand why the powers that be should be seriously looking at this as a model which would work on care and cost both.

What more could we ask?

New York Times

…“The Duke clinic represents a promising approach to delivering better health care: the so-called medical home. As President Obama and Congress try to create a national system that provides better care for more people at lower cost, you are likely to hear a lot more about this idea.

“The term, coined by the American Academy of Pediatrics in 1967, is admittedly confusing. It does not mean a return to house calls. Nor need it apply only to people with complex health problems like those of the Odom family.

“Rather, it is an approach in which each person has a primary care doctor who heads a team of professionals — perhaps including a physician assistant, a nurse practitioner, a dietitian, a social worker and a pharmacist — to provide round-the-clock access to care.

“It is unlike managed care, in which primary doctors act as gatekeepers to specialists and the overriding goal is not managing care but managing costs. In a medical home, the family doctor helps patients get specialty care when they need it and, through electronic records, keeps careful track of treatments and informs specialists of the patients’ progress. The connections between the professionals who work on each case are seamless and convenient. Doctors and patients have easy access to medical information, and patients with chronic ailments are called regularly to reinforce treatment regimens and see how they are doing.” (Emphasis added)

Source: New York Times, June 22, 2009