The Case for Patient Centered Medical Home, Care Coordination and Population Health Wellness
The Affordable Care Act (ACA) is changing the way patients, physicians and clinicians interact with our healthcare system. At first glance, creating affordable healthcare for all is an amazing yet daunting initiative. In actuality, however, patients are now finding it difficult to get appointments with their overburdened clinicians, landing them square in the middle of an expensive emergency department (ED) visit. Many of these individuals have primary care clinicians but lack coordinated care management. They have real diseases, diabetes, HIV, congestive heart failure, just to name a few, but make frequent visits to the ER because… Because why? There is no one driving care coordination.
Here’s a real story. Although I only practice emergency medicine part time, I noticed that almost every shift I worked, either I or one of my colleagues would see the same patient repetitively. We are fortunate to have care managers in the ED but they are usually not available in the late evening so this patient was being seen, sometimes had a workup, sometimes not but was usually discharged and told to follow up with his primary care physician. He lives alone, has no social support system and has a real disease. Here is a man who should be part of a patient centered medical home, receiving coordinated care to prevent recurring ER visits. He, and many others like him, have fallen through the cracks. This patient was finally admitted, eventually accepting an assisted living arrangement, thus eliminating unnecessary visits to the ER and providing him a much better health and wellness solution. But could this have been done sooner? (more…)