Medical Homes: A New Model of Health Care is Coming to New Hampshire

(sound in Emergency Room) And who’s your regular doctor? Is there any chance you hit your head or anything like that…noise…and you were at home?
It’s a busy day at Cheshire Medical Center’s emergency room. [ER AMBI UNDER]
But the ER – indeed, this whole community hospital, in Keene – has been a lot quieter in the last two years than it once was.
And that’s by design.
Administrators here and at Dartmouth Hitchcock Keene, the adjoining medical clinic, are working hard to keep people out of the hospital.
And they’re succeeding: admissions have fallen by about 20 percent.
They’re keeping people healthier with a new model of care, called a medical home, which relies on teams of people to care for patients.
And rather than viewing a patient as a bucket of parts to be passed from one specialist to the next, the idea is to treat the whole person.
To do so, the medical home in Keene leans heavily on people like Terri Skantze.
(Skantze on phone) OK, OK, and drinking enough fluids? OK, and how are you sleeping at night? OK, no problem there.
Registered nurse Terri Skantze is what’s called a care coordinator.
She works for the medical clinic’s family practice – not for the hospital.
But every day she visits primary care patients who are in the hospital, and she calls them before and after their stays.
MORE TERRI PHONE CALL UNDER
It’s her job to knit together care that is typically fragmented, by making sure patients have what they need, wherever they are.
She also contacts patients who should be seeing their doctors but aren’t – like, for instance, diabetics who aren’t getting their blood checked often enough.
John Schlegelmilch is co-president and chief medical officer of the hospital and the clinic.
He says the medical home model is just one part of a larger goal.
Schlegelmilch is helping to lead Vision 2020, a community-wide plan to make Keene the healthiest city in the nation.
“If that’s your vision, then what you should be concentrating on is prevention, wellness, how do we change the behaviors of the people in our community so that they end up with fewer chronic diseases, less health care needs, fewer hospitalizations, fewer visits to the ER.”
One might imagine that patients would welcome the medical home model – a system of care designed to promote wellness.
Not necessarily.
Dr. Carlos Jaen of the University of Texas School of Medicine is a lead author of one of the first major studies of medical home pilots.
In 36 projects that ran in doctors’ offices nationwide, patient satisfaction actually dropped slightly.
“It wasn’t the sort of dramatic improvement we expected.”
The authors don’t really know why medical homes were unpalatable.
But Jaen mentions one possible reason.
“I think in part because the practice was so engaged in implementing all these changes that really redefine how people relate to each other, and since some clinics have been open for many years, that may have been disturbing to some patients.”
Jaen cautions that it’s still early, and that he expects patient satisfaction to improve.
Moreover, studies show that medical homes improve the quality of care by about 10 percent.
Cheshire Medical itself gets high scores on quality for treating heart attacks, congestive heart failure and other illnesses.
Given those results – not to mention federal incentives – more medical homes are likely to be in our future.
In New Hampshire alone, five big pilot projects are set to get rolling over the next year.
For NHPR News, I’m Elaine Grant.