Monday, February 9, 2009

"Medical Homes" - Latest Health Care Fad?

We're hearing lots of talk lately about the "medical home" model in health care reform. What is it exactly? Its hard to say.

United Health & IBM recently announced a new pilot program for the model, according to this article in the New York Times.

"UnitedHealth will try giving doctors more authority and money than usual in return for closely monitoring their patients’ progress, even when patients go to specialists or require hospitalization. The insurer will also move away from paying doctors solely on the basis of how many services they provide, and will start rewarding them more for the overall quality of care patients receive.

The new approach, which is also being tested in various guises by other insurers around the country, is known as the “medical home” model of health care. Many experts hope it will prove one of the best ways to rein in the nation’s runaway medical costs, while making people healthier. The theory is that by providing a home base for patients and coordinating their treatment, doctors can improve care, prevent unnecessary visits to the emergency room, reduce hospitalizations and lower overall medical spending. "

The plan seems short on details and some policy experts see it as just another fad. It may reduce costs for employers in the short term, but likely to not yield long term results.

What does this mean to breast cancer survivors?

  • Cancer coverage - Many insurers these days sell "cafeteria" plans - health plans that cover only a few health care services and may exclude coverage for chemotherapy, breast reconstruction, etc. Will the "medical home" model of health care reform include coverage for all types of health care services, or just primary care - the area of medical care they focus on?
  • Uninsured - The "medical home" model does nothing to provide coverage for those who have no health insurance. How does it make insurance available to workers whose employers don't offer it or to self-employed individuals who can't afford individual insurance?
  • Underinsured - What about medical co-payments, prescription coverage and pre-existing condition exclusions - problem areas that increasingly make cancer treatment unaffordable even for those with insurance?
  • Choice - The model described contracts with primary care physicians, restricting patients to a list of providers. How will this work for specialists, especially for cancer care?

I've just listed a few concerns, I'm sure there are others. Many of the solutions being proposed for health care reform are vague on details about how much health care coverage patients will receive when it comes to cancer care. Breast cancer diagnostic and treatment are highly specialized areas of medical care that aren't provided through community clinics and primary care practices. Beware of proposals that focus only on those areas.

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