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Among the significant changes Ehrenberger expects to see:
- Open schedules. Patients will be able to see their own doctor when they are sick. Traditionally, doctors are scheduled months in advance, leaving few slots for sick people who need to be seen immediately. Ehrenberger's practice will turn that system upside down and adopt what's called an open schedule. For example, a mother who has been up all night with a sick baby can call first thing in the morning, talk with a member of her health team and schedule a same-day appointment with her regular doctor.
- Focus on wellness. Under the current medical model, insurance companies reimburse doctors most fully for time spent doing procedures, rather than talking with patients. When a doctor sits down for 30 minutes with a diabetic patient to teach critical dietary lessons, the doctor sacrifices income. Under the medical home model, doctors will be rewarded for keeping patients healthy by coordinating care with other providers.
- Team approach. Each morning, Ehrenberger and his colleagues meet for a "team huddle." They try to anticipate their patients' needs, proactively prepare necessary immunizations or medical tests and help set goals for their patients. That's a dramatically different model than having doctors put out medical fires all day, with little time to help patients ponder health goals.
- Integrated technology and medical records. Ehrenberger uses a laptop to document each patient's medical history. Patients will have access to their medical records and can log in to check results for lab tests. If a patient has an emergency and visits a hospital, Ehrenberger will automatically get a notice in his email inbox of the hospitalization. His system will be linked to the hospital's records, so he'll be able to access his patient's chart and lab results.
The two-year pilot program is being tested in 17 family medicine and internal medicine practices along Colorado's Front Range. The Colorado Clinical Guidelines Collaborative (CCGC) provides technical assistance to help the practices apply for and receive certification as a medical home, as well as ongoing coaching as they work to achieve an integrated delivery model. CCGC brings together multiple national and local insurance companies, along with physician and patient representatives with the goal to improve the delivery and adequate reimbursement of primary care.
"Our health care system isn't sustainable," said Marjie Harbrecht, MD, who helped get the pilot established as CCGC's Medical/Executive Director. She says more personalized care will put the emphasis on prevention and managing long-term chronic conditions. "As one of our doctors said, 'It's the kind of care you'd want your Mom to have.'"
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