The Medical Home, sometimes referred to as the “Patient-centered Medical Home”, despite sounding like a website or new kind of residential facility, is gaining traction as a route to reorganizing the delivery of care to certain populations. Finding its foundation 40 years ago in pediatrics, it is now touted as the answer for primary chronic care improvement as well as payment. A recent search for those who are very successful with these programs has led Arnold Milstein MD, to draw some interesting conclusions about what makes for a “Medical Home Run”. Unwavering commitment to keeping patients out of the hospital is key. By the same token, though, a recent issue of Health Affairs has looked at a variety of controversies and claims regarding the medical home, from differences in its definition and components, to whether those who might be most interested in offering the medical home model in fact have the infrastructure to do so. Rittenhouse, Casalino, et al, found that large medical groups were better prepared with elements of infrastructure alone (e.g., patient reminders, physician feedback, electronic records and more) to offer this approach to organizing care delivery, but even they were not routinely ready to do all that the medical home model promises.

In reviewing the claims for this model, it appears there are two movies currently playing in local theaters: Medical Home: The Clinical Movie --- which is about organizing care delivery to be sure patients can rely on a single practice to be accountable for and responsive to their needs across the continuum of care delivery; and then there is Medical Home: The Payment Movie. Here the story is yet another transitional approach to curing the dissymmetry between high quality, patient-centric clinical processes and current payment models. Medical Home: The Payment Movie seeks additional dollars to pay for the infrastructure which makes coordination of care possible. In fact, were additional payment to be made for intrastructure alone, there is no guarantee any change in quality would result. Still, it is indisputable that it costs money to implement infrastructure that makes a medical home possible --- to use non-physicians to help engage patients in their own care, maintain registries and other electronic data to foster clinically important interactions with patients and to keep tabs on the care they are getting.

The PROMETHEUS Payment® Model is highly consistent with the Clinical Movie script and is even better than the transitional, small-additions-to-current-payments storyboard of the Payment Movie. Also intriguing is the application of the medical home clinical approach to other types of care, like hematology-oncology. Those physicians are losing their business model based on drug payments and ought be paid for the care and coordination that are the core of what they do. Infectious disease physicians have similar issues, as do rheumatologists treating arthritics. The basic premise of the Clinical Movie is not only viable for primary care. It deserves consideration elsewhere. Elements of it are consistent with UFT-A principles as well.