The Medical Home Revolution

A new way of interacting with physicians feels like a throwback to some golden age of health care.
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The idea alone horrified Group Health family doctor Harry Shriver: Answer his own phone—without a nurse screening calls first? Give patients his e-mail address?

It’s not that Shriver, now Factoria Medical Center chief, considered himself too important for such mundane tasks. It’s just that from the moment he walked into the clinic, he literally went from exam room to exam room, typically seeing as many as 22 patients a day, with problems from the simple (a case of the flu) to the complex (an elderly person with both diabetes and heart disease).

Today, Shriver sees half as many patients in a day, and spends up to 30 minutes with each. That gives him time to really communicate with patients, to sort through health concerns, physical and emotional. He picks up the phone when his patients call, and he answers their emails.

He’s never been happier—and he believes his patients have never been healthier. Emergency room visits are down for his patients, and they follow medical orders better.

It’s all part of a relatively new approach to health care known as the medical home model, and for supporters, it holds the key to reforming the nation’s health care. “Patients love it,” says Alicia Eng, Group Health’s clinical operations administration director. Eng helped guide the clinic through the transition from conventional practice to the medical home model in 2009. The Group Health Research Institute tracked, analyzed and studied the medical home experiment from the start.

And it was good. The study showed decreased per patient costs and better health overall for them. Group Health leadership decided to roll out this model of care to all 26 of its medical centers.

Janet Nolte, a Group Health nurse who works in the Factoria clinic, likens the approach to a wheel with spokes. The doctor and patient are at the center of the wheel, and others—nurses, medical assistants, pharmacists—are the spokes that support that relationship. The glue that holds the program together is electronic medical records, which means all those on a patient’s health-care team can instantly access vital information when a patient e-mails, calls or visits.

Longtime Group Health family medicine physician Suzanne Spencer, who was medical director of the Factoria Clinic when the plan rolled out, is now retired but fills in for doctors. She says the amount of time she now spends with patients makes her a better doctor. According to studies by Group Health and others, the medical home model has meant better health and greater satisfaction for patients, and less burnout and more career satisfaction for doctors and nurses.

Seeing medical home as the future for primary care and impressed with results in its clinics, Group Health executives decided to adopt the new medical home approach in the construction of new medical centers. A prototype was created in an empty warehouse in Tukwila (shown above; photo courtesy of Group Health), with architects, builders, nurses, medical assistants, doctors, and patients participating, to model patient flow. “It was a full-scale mock-up, complete with furniture, exam rooms, lobby­—everything that we could move around until we got it right,” says Group Health spokeswoman Katie McCarthy. “Think lots and lots of cardboard.”

That work resulted in the design of the new Puyallup Medical Center, scheduled to be completed in December 2012 and a new medical center in Burien, scheduled to open in 2014. It’s also created improvement projects that will be implemented in other medical centers, McCarthy says. ✚