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Minnesota should expand ‘medical homes’ concept

Your child is sick. Maybe it’s since the child was born, or maybe it’s some evil ailment that reared its head later in life. All you know is that now your life revolves around doctors, pharmacies, and insurance claims. The mailman has ceased to be your friend. You may have even had to quit your job or alter your hours to accommodate the never-ending parade of appointments. The lists only amplify the stress and tedium that accompany this life. Lists of medicines to make sure that the different specialists don’t prescribe conflicting drugs with potentially fatal side effects. Lists of different therapies from different doctors that might counteract each other.

The possibility of lists is endless. And without constant updating, all that work can be worthless.

Decades ago, Minnesota started trying to address this issue by implementing what are known as medical homes. Medical homes are supposed to work like the lists family members lug from appointment to appointment. A medical home, loosely defined, is the idea that every child dealing with a chronic issue should have a central physician’s office that tracks the care the child receives. That’s one more member of the “home” to track what is being prescribed, or to let all the medical professionals involved know if there’s a potential conflict. It’s proven to be a lifesaving measure. And as of last summer, the state decided that all Minnesotans dealing with chronic issues should have access to the medical home model.

One doctor to track treatment
Medical homes are an idea as old as the medical community: one doctor to track treatment for one patient. But as doctors have become more specialized and insurance more complicated, going to one doctor has been an isolated experience, often leaving patients to coordinate their own care. The current use of medical homes for children with chronic issues has taken some burden off families and allowed doctors a more free flow of information. It has allowed doctors to meet with children and their parents for longer periods of time without being penalized by insurers. The medical home model gets rave reviews from both doctors and families alike. So when Minnesota started to look at expanding the current model, it met with a positive response.

“I’ve been hearing about medical homes since the 1980s,” said Dr. Jeff Schiff, the Minnesota Department of Health’s team leader in implementing medical homes statewide.

The medical home (sometimes referred to as a Health Care Home, or HCH) allows one professional involved with the case to act as a central clearinghouse for other professionals involved to shuttle information to. Oftentimes the central professional is a primary care physician, but the updated model would allow others, such as social workers or a specialist to become the primary agent. That person’s office would then track all care the patient was receiving, from prescriptions to major surgeries. It’s more efficient for the patients who often lug pill bottles and large notebooks from location to location. It’s more efficient for medical professionals, who would have access to updates instantly and be able to adjust care accordingly.

Expansion considered

This past summer, the Department of Health approved funding to look at expanding the medical homes concept to include all Minnesotans with chronic conditions. The goal is to try to move the policy from theory to practice in the next year. And that’s not going to be easy.

For policy to move out of the realm of theory to practice is a long process. Dr. Schiff and his colleagues have been working to make medical homes a reality for quite a while. And while implementing the program in a broad sweep would be ideal, the expansion of medical homes will be incremental. First would come those on Medicare, Medicaid, then people on other forms of Medical Assistance. Finally the program is hoping to expand to those with private insurance. While that seems to penalize those lucky few with insurance of their own, the plan is moving forward. A multilevel approach to implement this program could mean the difference between some Minnesotans benefiting or none at all.

With Minnesota’s $5.5 billion revenue shortfall looming, everyone is nervous about implementing new programs. Even though the initial approval came this past summer, the future is one step at a time. At a recent meeting of the Health Care Reform Review Council the tone around the table was a nervous one. Members of the council posed the question of funding as the first question of the meeting as well as the last question of the meeting. Even programs with already approved funding are at risk. Medical homes, however popular, are only as safe as any program is at this point.

“This is an incredible opportunity, as well as presenting some incredible challenges,” said Schiff. “We want to be able to say Minnesota has a family and patient centered health-care system.”

As the revenue shortfall becomes a reality, Minnesotans need to stay hypervigilant. We need to make sure investments that benefit our communities are preserved. We need to ensure new ideas that could change the quality of lives across the state are given room to breathe and grow. Even in this time of panic-inducing economics, we should always move Minnesota one step closer to the kind of quality care we all deserve.

Elizabeth Rich is a graduate research fellow for Minnesota 2020, a think tank based in St. Paul. This article originally appeared on its website.

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Comments (1)

  1. Submitted by david zander on 12/23/2008 - 09:24 pm.

    Very helpful, very informative. Thank you Elizabeth. I had first heard the concept of a medical home mentioned by Seenator Berglin this summer at a meeting on health disparities – had googled and found some infornmation – but have been wondering what window of opportunity it presents to the Southeast Agencies, community health workers and their client families who struggle between the western and traditional health beliefs systems and how to improve their access to quality health care.
    (David Zander
    Council on Asian Pacific Minnesotans

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