SEATTLE, March 27, 2009 -- Today Swedish hosted a ribbon cutting and openhouse to celebrate the upcoming opening of its newest primary-care clinic, which will be the first at Swedish – and the first in the country – to open utilizing the 'medical home' model exclusively from day one. This innovative approach to health care involves a patient-centered team of caregivers as well as information technology to provide better access for patients. This model is also innovative because it involved insurance providers in the development of the clinic. The clinic, which officially opens to the public on Tuesday, March 31, will serve as a Family Medicine Residency training site. Swedish is excited to pilot this project and offer this new model of health care to the community.
Swedish Medical Center's administration and Program for Primary Care and Community Health have taken a bold step in addressing one of the unresolved issues of America's current healthcare crisis: access to comprehensive, quality primary care – the cornerstone of basic health care. In late March, Swedish Family Medicine will open a primary-care clinic on the Swedish/Ballard campus using the medical-home concept advocated by the American Association of Family Physicians, the American Academy of Pediatrics and the American College of Physicians. The goal is to build a successful practice on the tested and proven premise that the best quality of care stems from patient-centered, medical-team-guided, cost-effective, longitudinal care, rather than illness-oriented, complaint-based, intermittent care.
A shift in care delivery in America
Neighborhood physicians in 18th and 19th-Century America often were like members of the family. The family doctor knew the special needs of all family members and tracked their health over their lifetimes. That form of care delivery significantly changed during the 20th Century due to urbanization, population growth, the advancement of medical technology and physician specialization, and the advent of health insurance. Despite television shows in the 1960s and 70s that romanticized family doctors, there was a dramatic shift away from primary care. Today specialty care is dominant and fewer physicians are choosing primary care as a specialty.
Last year the number of unemployed and working poor in America increased as employers implemented cost savings by laying off employees, and reducing or eliminating health benefits. Uninsured and underinsured families tend to delay routine medical exams and testing, and often rely on the emergency room for non-emergent medical care. On the other end of the economic spectrum, individuals who can afford to purchase better access are choosing to pay additional premiums and fees to enroll in concierge practices. Additionally, Web-savvy Americans often are self-diagnosing and seeking episodic specialty care, rather than the comprehensive, coordinated care in a primary-care practice.
Growing concerns about physician workforce shortages, as well as access disparity among population groups and geographic locations, are symptomatic of an unhealthy health-care system and contribute to the overall decline in the health of Americans.
The rebirth of the medical-home model
Swedish Community Health, the new Swedish medical-home practice, has built its delivery model and infrastructure to concentrate on continuity of care, with patient wellness as the ultimate goal. Medical teams, which will include family-medicine faculty and residents, mid-level providers and nurse care managers, will use evidence-based guidelines to focus on preventive, chronic and acute care, as well as health maintenance. Nurse care managers will help patients navigate the medical experience by teaching them to access their own medical records via the Internet, and by facilitating communication among team members and specialists.
The 2,000 enrolled patients who will be part of this pilot program will reflect the real world -- including patients commercially insured, and also Medicare Advantage, Medicaid, and uninsured self-pay and subsidized patients. This unique program improves access to a broader suite of services than currently exists in many other medical-home models, enhances the patient experience through education and group sessions, and provides better coordination with an array of private- and public-sector institutions with which Swedish has partnered.
"In essence, we are taking concierge care and applying it to everyone," says Jay Fathi, M.D., medical director of Primary Care and Community Health at Swedish Medical Center. "Family physicians are drawn to family medicine because they like to care for entire families and because they want population-based diversity in their practices. This medical-home concept also eliminates one of the main frustrations of primary-care physicians: the appointment treadmill. A multitude of short appointments doesn't give us time to effectively address the whole patient or to utilize wellness behavior management, which can have such beneficial outcomes."
In its "Health of Washington State" 2008 update, Washington's Department of Health suggests adults and children who have medical homes are more likely to "access preventive services, including annual physical exams, developmental screenings, health education, immunizations, well-child care, and other medical and community-based services."
"Our bottom line will be the long-term health and well being of our patients," says Carol Cordy, M.D., medical director for the new clinic. "Spending the necessary time to really get to know our patients, providing 100 percent of the recommended preventive care and keeping their chronic conditions in excellent control will help them stay out of the emergency department and hospital, and will help control costs for both patients and payers."
In this capitation-based business model, physicians essentially will be prepaid to deliver necessary care using the most appropriate type of visit, including visits via e-mail and telephone, and group visits. Patients often see this as an enhancement that reduces unnecessary clinic visits, and provides more convenient and timely access. Physicians, who no longer have to view clinic visits as the only source of payment, are able to better utilize their time and spend more time with patients when they do have clinic visits.
Another anticipated benefit of this care model is a stronger, more efficient relationship with specialists that promotes better communication and care coordination. Specialists also will see appropriate referrals, rather than referrals that could, or should, have been taken care of in a primary-care setting.
"As physicians," says Fathi, "we can't expect America's health-care system to fix itself. We must be proactive and use tools that are available to us to help improve access and reduce costs, while providing evidence-based, quality care."
This rebirth of the medical-home concept has great support from Swedish administration, and from the Swedish Medical Center Foundation, which is helping fund the project through philanthropic contributions and private fundraising. The program also has support from the Washington State Department of Health, members of Washington's congressional delegation, and multiple payers who have embraced this creative solution because they understand the future of health care in America depends on primary-care clinics.
For more information about the medical-home concept or the Swedish Community Health practice, call 206-297-5100, e-mail firstname.lastname@example.org or click here.
- To read a related article posted on www.crosscut.com on Sept. 3, 2009, click here.
- To read a related article posted on www.myballard.com on April 1, 2009, click here.
- To read a related article posted on www.localhealthguideonline.com on March 30, 2009, click here.
- To read a related article posted on the Ballard News-Tribune Web site on March 27, 2009, click here.
- To read a related article published in the Jan. 18, 2009 issue of The Seattle Times' Pacific Northwest magazine, click here.
- To read a related article published in the Dec. 21, 2008 issue of the Seattle Post-Intelligencer, click here.
- To watch a related story on the KCTS Television Web site that aired Jan. 8, 2010 as part of the PBS station's 'Connects' program, click here.