Grantee Story
Patient-centered Medical Home Pilot
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Imagine a doctor’s office that revolves around the patient. A caring team knows your name, greets you with a plan to achieve your health goals, answers emails quickly and clears the calendar so you can get an appointment immediately when you’re sick.
David Ehrenberger, MD, of Broomfield Family Practice is eager to provide such service under a groundbreaking national pilot program. Supported by The Colorado Trust, along with The Commonwealth Fund and the Harvard School of Public Health, the pilot will test a system called “patient-centered medical homes.”
The title can be confusing; a medical home is not a place, like a nursing home. Rather it’s a philosophy of providing care that evokes trust, warmth, quality and a long term relationship with medical providers who know you. At a practice that adopts the medical home vision, patients should feel like they’ve found a partner to heal them when they’re sick – and set a course to keep them well.
“It’s like Marcus Welby on steroids,’’ Ehrenberger said of the concept, describing both its patient-centered focus and the powerful technology that will boost communication, cut errors and increase cooperation among health professionals.
Ehrenberger became a family doctor so he could build relationships with patients like Welby, the legendary TV doctor. Two decades into his career, he found himself sprinting on a treadmill, trying to see more and more patients each day to keep up with costs. Increasingly, paperwork and insurance snafus were bogging him down.
Under the medical home system, Ehrenberger envisions a much saner system. He’ll actually get paid to keep patients well, not to simply shuffle them in and out as fast as possible.
“We’re definitely pioneers,” he said. “You can’t just say you’re doing it. You have to prove it. It’s nothing short of a revolution.”
Among the significant changes Ehrenberger expects to see:
- Open schedules. Patients will be able to see their own doctor when they are sick. Traditionally, doctors are scheduled months in advance, leaving few slots for sick people who need to be seen immediately. Ehrenberger’s practice will turn that system upside down and adopt what’s called an open schedule – for example, a mother who has been up all night with a sick baby can call first thing in the morning, talk with a member of her health team and schedule a same-day appointment with her regular doctor.
- Email access. Doctors will schedule time to counsel patients by email to reassure them about proper medication dosing, remind them of chronic concerns or suggest that they come in to be seen when necessary.
- Focus on wellness. Under the current medical model, insurance companies reimburse doctors most fully for time spent doing procedures, not talking with patients. When a doctor sits down for 30 minutes with a diabetic patient to teach critical dietary lessons, the doctor sacrifices income. Under the medical home model, doctors will be rewarded for keeping patients healthy. So, a doctor could focus on dietary education or hire a dietician to work with multiple patients.
- Team approach. Each morning, Ehrenberger and his colleagues meet for a “team huddle.” They try to anticipate their patients’ needs, proactively prepare necessary immunizations or medical tests and help set goals for their patients. That’s a dramatically different model than having doctors put out medical fires all day, with little time to help patients ponder health goals.
- Integrated technology and medical records. Ehrenberger uses a laptop to document each patient’s medical history. Patients will have access to their medical records and can log in to check results for lab tests. If a patient has an emergency and visits a hospital, Ehrenberger will automatically get a notice in his email inbox of the hospitalization. His system will be linked to the hospital’s records, so he’ll be able to access his patient’s chart and lab results.
The two-year pilot program is being tested in 16 family medicine and internal medicine practices along Colorado’s Front Range. First, the practices get certified as medical homes, then they get coaching and technological assistance from the Colorado Clinical Guidelines Collaborative (CCGC). The Collaborative brings together multiple national and local insurance companies, along with physician and patient representatives.
“Our current health care system isn’t sustainable,’’ said Marjie Harbrecht, MD, who helped get the pilot established as CCGC’s Medical/Executive Director. She says more personalized care will put the emphasis on prevention and managing long term chronic conditions.
“As one of our doctors said, ‘It’s the kind of care you’d want your Mom to have.’’’
