Medical ‘home' could give patients more coordinated care
After losing his health insurance, Jay Feldman stopped seeing his regular primary care doctor to help him manage severe joint inflammation, borderline diabetes and other medical problems.
"I went for a year without a primary care physician, and it was not fun," said Feldman, a 54-year-old East Lyme resident. "The first thing that went was my prescriptions, because I couldn't afford them. I wound up at Pequot (Health Center) three times in two weeks in all kinds of pain."
Now, after qualifying for state-subsidized health insurance, Feldman, a contractor who buys and fixes up multifamily homes, is feeling much better about his medical care. He's become a regular patient of Dr. Jenny Hyppolite in Groton, where regular checkups to monitor his medications and his blood sugar, joint pain and migraine headaches are working to keep his conditions under better control, he said. Hyppolite has also referred him to a sleep lab and other specialty care.
"I do feel the sense that this is where everything comes together," said Feldman, just before the medical assistant called him into the exam room to begin a recent check-up.
Feldman may not use the term, but what he's found at Hyppolite's office is what health reform advocates refer to as a "patient-centered medical home," a concept proponents see as a way to improve health care while also improving efficiency and reducing costs. Under this model, each patient would have a primary care doctor who coordinates his or her care among various specialists and providers, acting as the leader of a team.
"It's a whole-person orientation that reduces fragmentation of care," said Dr. Karen Boudreau, senior vice president of the Institute for Healthcare Improvement. "It follows evidence that increasing coordination results in better outcomes and reduces costs. A lot of it is really about the doctor and patient getting to know each other and building a relationship."
The concept has been embraced by many groups, including the Joint Commission, which accredits hospitals, and the Connecticut State Medical Society, which this year joined with the American College of Physicians to offer software specially designed for practices that want to become patient-centered medical homes. Recent studies by the Commonwealth Fund and other research organizations show chronic conditions such as diabetes, asthma and congestive heart failure are better managed in medical home settings, with patients having fewer hospitalizations.
Leading the push for more practices to become medical homes is the Patient-Centered Primary Care Collaborative, a nonprofit established in 2005 whose membership includes about 200 patient and health care quality organizations, physician groups, hospitals and other health care providers, major employers and insurers. Among the collaborative's goals is to advocate for a change in the way primary care is reimbursed by insurers, so that a primary care doctor can be compensated for coordinating a patient's care as well as for office visits.
"Care delivered by primary care physicians in a patient-centered medical home is consistently associated with better outcomes, reduced mortality, fewer preventable hospital admissions for patients with chronic diseases, lower utilization, improved patient compliance with recommended care, and lower Medicare spending," the collaborative states on its website, citing several studies by outside groups.
Dr. Hyppolite opened her Groton practice in August, after several years of providing care in New York state and then in North Carolina. In medical school, she considered becoming a surgeon or an emergency room specialist, but ultimately settled on primary care because that's where she saw the biggest need.
"What was lacking was continuity of care, and I was looking to provide that," she said.
Part of being a medical home is providing preventive care as well as treating symptoms, and attending to "the whole person," with advice and referrals for mental health as well as specialty physical care, said Hyppolite, adding that she frequently draws on her background in psychology.
"And it's also about knowing when to refer and whom to refer to, and what you're referring for," she said. "I try not to refer too much. Some people want to go to a specialist before primary care, and they end up having more tests and more anxiety. Are you really improving a person's quality of life that way? Probably not."
As a new physician to the area, Hyppolite has been building her practice "from zero." Many of her patients have been without primary care for several years, she said, having been referred to her for follow-up care after a recent visit to the emergency room. Some, she said, thought they were healthy and didn't need a regular doctor — until some crisis changed their minds.
During a recent appointment, Hyppolite asked Feldman about stress and his diet, when his migraine headaches happen and his blood pressure and blood sugar levels since his last visit.
"Your blood pressure's perfect right now, in the low-to-normal range," she said, checking the results on a computer screen in the exam room. A medical assistant entered the room to take a small blood sample from his finger for a blood sugar test.
"When I came here I was borderline diabetic," Feldman said. "I take my blood sugar every day now, and it's getting better."
At United Community and Family Service in Norwich, Andrea Dameron, an advance practice registered nurse, or APRN, also aims to follow the medical home model with her patients, many of whom have also been without a regular primary care provider for several years. Some have been without insurance and recently qualified for Medicare or Medicaid, "and they're tired of not feeling good," she said. Like Hyppolite, Dameron is also a new primary care provider in southeastern Connecticut.
"Some of my patients have never had anyone coordinate their care for them, and didn't realize they needed that," she said. "I love the concept of the medical home. Patients need people who know all about their medical history."
Among Dameron's patients is Alicia Garrett, who came to UCFS after she lost her private health insurance. The 55-year-old Norwich resident was without coverage for three months before she qualified for Medicaid. During the three-month gap, she said, she had to go to the emergency room to get a prescription refilled. Garrett said she has diabetes and a chronic back condition, and tried as best she could to monitor the conditions on her own.
"But it was very scary, because my diabetes has been up and down a lot," she said.
Now, Garrett said, her diabetes is stable. Dameron has also referred her for mental health counseling to help her deal with the emotional effects of her chronic back pain, which was caused by an injury.
"It's very important to have regular primary care," Garrett said. "They get to know you as an individual, not just a number. They can't help you if they don't know you."
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