Medical home method already in use at UNC

Even if the U.S. Congress passes a sweeping health insurance reform bill it is working on, that is only the first step in health care reform. The nation will still be plagued by a delivery system considered broken and ineffective.

But doctors at UNC might have helped develop a cure — the medical home approach.

The system is an approach to health care delivery that focuses on strong relationships and frequent interaction between patients and doctors.

The UNC Internal Medicine Clinic and the Department of Family Medicine practice both employ the system for primary care patients. Primary care includes routine checkups and initial trips to the doctor when patients think they’re ill.

Patients in the medical home system at UNC often have interaction with more doctors during visits, receive assessment calls between visits and are given medical literature to help prepare them for appointments.

The delivery system was mentioned in President Barack Obama’s overall health care strategy. And during a press conference in September, Kathleen Sebelius, U.S. secretary of health and human services, called the medical home “a great experiment taking place in various parts of the country, lowering costs and delivering high-quality care.”

The U.S. Senate is currently crafting their version of a health care reform bill that could be melded with the one passed Saturday by the U.S. House of Representatives. Both are designed to drastically expand the availability of health care insurance.

Dr. Michael Pignone, an assistant professor of medicine, is one of the physicians who has led the implementation of the medical home system at UNC. He and his colleagues, Dr. Robb Malone and Dr. Carmen Lewis, arrived at UNC Hospitals in the late 1990s to find an uncoordinated system focused on individual decision making.

“Everyone was trying to do the best they could, but they weren’t working together,” said Pignone, who compared it to 25 solo practitioners sharing the same work space.

“It leads to a lot of error. We said, ‘There’s got to be a better way to do this.’”

They learned that their patient-focused and collaborative ideas matched up with the medical home concept, which originated in 1967, and began implementing the system.

UNC’s experiment has reached into many areas, all focused toward creating a more efficient, collaborative practice. For example, medical records have moved to an electronic format to better track progressions in chronic-care patients and find trends. And by delivering information to patients at home and in the waiting room, patients can be more involved in making decisions.

The potential changes to national health care currently being discussed likely haven’t focused on medical homes. But further reform will likely focus on delivery.

“Insurance has an indirect effect on how its delivered,” Pignone said of health care. “It probably won’t be fixed with just insurance.”

But a lot of eyes are on the work taking place at UNC.

“We’re trying to lay the framework for what the practice of the future should look like,” Pignone said.

Many hope the trial runs of the medical home system will make transitions easier by the time attention has shifted from insurance to practice.

As use of the medical home system grows, it won’t be without potential drawbacks.

Some critics, for example, have said the focus on primary care takes too much attention away from other things like psychology and eye and vision care.

So far, UNC patients have responded well to the medical home system. Pignone said their work has also helped with promotions and grants.

And if it has thrived here, it might be able to do even more good in other nonteaching hospitals. Pignone said UNC isn’t his ideal grounds for experimenting with medical homes, citing the high yearly turnover in resident doctors.

“That’s going to be the test,” Pignone said. “Can we take it outside the University and make it work on a broader scale?”



Contact the University Editor at udesk@unc.edu.