Comments on: Medical Homes — And Medical ‘Home Runs’?

By: If They Build a Medical Home, Will the Docs Come? | Diario BV

If They Build a Medical Home, Will the Docs Come? | Diario BV — Thu, 02 Apr 2009 05:12:32 +0000

[...] achieve HEDIS benchmarks. Keeping patients away from the emergency room or the hospital requires a zealous amount of hustle that goes well beyond the 8-5 business day. And, as the DMCB understands it, much of the [...]

By: Welcome to the Health Wonk Review, Political Convention Style | Diario BV

Welcome to the Health Wonk Review, Political Convention Style | Diario BV — Thu, 02 Apr 2009 05:03:07 +0000

[...] Arnold Milstein, who uses the Health Affairs bully blogpit to distinguish between medical homes and medical home runs. The DMCB thinks this makes for interesting not only because it has had its own doubts, but because [...]

By: More Views on the Patient-Centered Medical Home | Information Therapy (Ix) Blog

Tue, 24 Mar 2009 15:55:21 +0000

[...] Arnie Milstein, MD, from the Pacific Business Group on Health, found four practices that effectively demonstrated how PCMH approaches can lower total health care costs. They relied on two re-engineering goals: (Primarily) lowering the frequency of health crises (acute events) and (secondarily) reducing the cost per service. They applied three ingredients to these two goals: Salient caring (tailored to reduced hospital use), team-based production, and tight supplier management. It’s also worth reading Milstein’s Health Affairs piece titled “Medical Homes and Medical Home Runs.” [...]

By: Welcome to the Health Wonk Review, Political Convention Style « Small Diseases

Sun, 08 Mar 2009 23:24:03 +0000

By: If They Build a Medical Home, Will the Docs Come? « Small Diseases

If They Build a Medical Home, Will the Docs Come? « Small Diseases — Sun, 08 Mar 2009 23:11:37 +0000

By: PookieMD

PookieMD — Wed, 08 Oct 2008 17:30:27 +0000

Medical Homes sound great on paper, but Mr. Milstein is missing a key component–who will do the work? He sites physician “zealots” who make it their mission to utilize resources effectively. The painful point is this: physicians don’t want to do primary care! The reimbursement is low, the hours long, and adding in the requirement of “zealotry” doesn’t make it any more attractive. Medical homes will be successful only when they are appropriately funded, and physician time is adequately rewarded. (Only 3% of todays internal medicine residents, the ones that would actually take care of these patients, want to go in to general internal medicine!) I applaud the concept, but frankly, much will have to change in order for this model to become an effective way to practice, and attract physicians to do the work.

By: Blogtica.com » Medical Homes — And Medical ‘Home Runs’?

Blogtica.com » Medical Homes — And Medical ‘Home Runs’? — Mon, 22 Sep 2008 13:10:48 +0000

[...] post by Arnold Milstein and software by Elliott [...]

By: Health Affairs Blog - Medical Homes — And Medical ‘Home Runs’? | Ted Eytan, MD

Thu, 18 Sep 2008 03:51:41 +0000

[...] Health Affairs Blog – Medical Homes — And Medical ‘Home Runs’? – Commentary from Arnold Milstein. The suggestion is that to be successful, "personal zealotry" is still required, even with a modified reimbursement environment. How does this become "standard" instead of the exception? [...]

By: A Healthy Blog » Medical Homes — More Evidence of Improved Quality for Less Cost

Sun, 14 Sep 2008 16:50:15 +0000

[...] Commenting on the study, Arnold Milstein found a very human element is critical if medical homes are going to reduce costs and improve care: At least one primary care team member demonstrates saliently to each chronically ill patient that they care deeply and personally about them and protection of their health. This includes mobilizing family members, social services, and other resources required for successful patient self-management. In addition, as soon as a chronically ill patient senses impending health crisis, a member of the health care team familiar with their history is readily reachable and prepared “to go the extra mile” to prevent hospitalization, including actively coordinating with ER physicians and hospitalists in exploring alternatives to hospitalization. [...]

By: DrEric

DrEric — Fri, 12 Sep 2008 19:46:13 +0000

As an alternative to Dr. Milstein’s physician-based medical home, the “personal-nurse” medical home used by several large employers (JC Penney is one) has led to decreased healthcare costs through decreased ER visits and decreased hospitalizations. A presentation by JC Penney showed that the telephonic personal-nurse model led to a reduction in annual healthcare cost inflation from 12% to 8%, even while JC Penney expanded their coverage to provide a richer health plan for its employees. Rather than being skeptical of an employer-sponsored nurse, the employees greatly valued their services as alleviating many of the logistical burdens of care that they had previously carried.

As primary care is still largly a disorganized cottage-industry, I believe the implementation of an employer or government-based personal nurse medical home will be far more effective… and that’s even coming from and MD!