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Articles / 2007

Patients find comfort in 'medical homes'

Ventura County Star
Thursday, 09/20/2007
By Michelle L. Klampe

Marisela Magallanes knew she'd found her medical home when her new physician called her to discuss a complaint she'd made regarding wait times.

Magallanes, 30, a county employee who uses the Magnolia Family Clinic in Oxnard for her primary healthcare, had recently started seeing Dr. Stan Patterson, a family practice physician there. A lengthy wait one day had her rethinking her choice; she left without seeing her doctor and complained to the clinic manager.

She was surprised when Patterson called her at home shortly afterward and invited her back to his office to discuss the issue. Patterson's willingness to listen, to address her complaint, and to treat her medical needs with care and compassion proved to Magallanes he really was the doctor for her. The wait times got shorter and she made his office her medical home.

"He listens. I don't ever feel rushed when I come to see him. He takes his time to explain what's going on," Magallanes said. "I've been to so many doctors, and this is a keeper."

A "medical home" is a place where a patient can "develop a true attachment to a medical provider at that site," said Dr. Robert Gonzalez, medical director for the Ventura County Health Care Agency. "The provider feels responsible for and helps take care of the patient.

"We think this is the best model of care," he said.

Establishing a medical home essentially means having a regular physician to provide ongoing medical care services, including preventive care and management of chronic conditions. The term has been in use for more than 40 years, but in recent years has become the prevailing description of optimal care for patients in a primary care setting.

In March, the national associations representing the main primary care physician groups, including pediatricians, family practice physicians and osteopaths, adopted a set of joint principles outlining what a "medical home" means to them. The principles include providing each patient with a personal physician; coordinating and integrating care and services, such as specialists, home health and hospital stays; giving patients an active role in decision-making; and enhancing access to include expanded hours and ease of scheduling appointments.

Homes have benefits

Establishing a medical home generally leads to better patient outcomes, since patients receive regular care and preventive exams and tests, leading to early detection and better management of illness or chronic disease such as diabetes or high blood pressure.

A medical home might also be the answer to eliminating health disparities for Latinos and blacks, who are more likely to be uninsured and less likely to receive regular medical care, according to a June report issued by The Commonwealth Fund, a private nonprofit foundation promoting better access and improved quality of the nation's health system, particularly for vulnerable populations.

"No matter where we looked, it made a big difference—access, chronic conditions, preventive care—having a medical home made a big, big difference," said Dr. Anne Beal, one of the report's authors. Beal, a pediatrician, is assistant vice president for the fund's program on quality of care for underserved populations.

"The real dividing line is between who's insured and who's uninsured."

Nearly half of all Latinos and more than a quarter of blacks in the U.S. were uninsured in 2006, compared to 21 percent of whites and 18 percent of Asian Americans, according to a healthcare quality survey conducted by the fund and cited in its report. More than 40 percent of Latinos and 21 percent of blacks reported they have no regular doctor or source of care, compared to 15 percent of whites and 16 percent of Asian Americans, the survey found.

One of the best ways to improve care for minorities is to promote the concept of the medical home within community health centers and public clinics, Beal said.

Community Memorial Hospital is using the medical home concept in its system of nine clinics throughout western Ventura County. The Centers for Family Health, which launched in 1994, recorded about 230,000 patient visits last year, a combination of private insurance, Medi-Cal and self-pay, said Dr. Richard Reisman, medical director for the clinics. The numbers, which are increasing by 10 percent to 15 percent each year, are a testament that the medical home concept works, he said.

Centers keep patients happy

A customer service approach helped establish the centers' reputation in the community, he said. Patients who use the clinics can usually get appointments the same day if needed, or within a day or two for a routine issue. The system of clinics offers extended hours, urgent care services, and physicians who are on call during evenings and weekends, should an emergency arise. The centers also emphasize preventive care and use a system of health educators to work with patients on managing medical issues such as diabetes.

The clinics had a high no-show rate at first, as patients got used to the new model, but now they respond well to the idea of having a regular doctor, said Petra Luna, who oversees the health education program for the centers.

"You're not seeing a new person and telling them the same story over again," she said. The patients also are adjusting to the idea of coming to the doctor even if you're not sick, she said.

"Over the years, we've been able to educate them on the process of coming in to do a checkup versus waiting until multiple problems show up. The whole concept is a preventive approach."

The Ventura County Health Care Agency also has adopted and now promotes the medical home philosophy in an effort to improve care and reduce the high costs that go along with untreated illness or unmanaged disease.

"A bladder infection in a 60-year-old is quick and easy to treat with a three-day antibiotic," said Gonzalez, the medical director. "But if you don't treat it, the bacteria can go into the bloodstream and turn into sepsis and require hospitalization."

For patients like Magallanes, who has insurance, the county's effort means having a doctor like Patterson who is accessible and responsive to her needs. Uninsured patients get the same care, as well as information about programs that can help them pay for their healthcare, through a government program or at a reduced cost if they are eligible.

The county's newest program for the uninsured, Access Coverage Enrollment, or ACE, was designed to mimic a typical insurance plan. Participants in the program, which launched Sept. 1, will pay a small annual enrollment fee and co-payments for some services, though many preventive services are provided without any co-pay. Enrollees, who must meet income requirements and not be eligible for other private or public insurance programs, receive a benefit card similar to a typical insurance card.

"The card is the key," said Mike Powers, director of the Health Care Agency. "The card is that anxiety-easer."

Insurance isn't the only key to creating a medical home, though. Patients must also have easy access to clinics and be able to get appointments quickly. They must trust their physician, and they need to feel comfortable in the medical office, not just with the doctor, but also with the staff; bicultural and bilingual physicians and clinic staff help in that regard.

"I know I have to build that trust," said Patterson of the Magnolia clinic, who speaks Spanish. "If a relationship is not good from the start, patients will make that choice and just won't see that doctor. Once that trust is built, you can see an improvement in compliance — they stick to their med schedules, their return visits are better, you get better outcomes."