Transforming Primary Care

This article proposes an alternative structure of the medical home model to improve health and lower costs, particularly for the frail elderly population. While the medical home, which centers care around patients and their primary care physicians, has many strengths, it also has shortcomings. The authors describe a potential alternative to the current medical home model that addresses these shortcomings.

The traditional medical home arrangement places responsibility for coordination of care under primary care physicians, which can limit the scope of coordination to primary care services and laboratory results. Current medical home programs also do little to address the home and community context of patients.

The authors propose a program called Care Plus. Care Plus would feature a number of services to streamline and improve medical care.

Services provided would include:

  • A wide range of directly-provided primary care and support services that are cost-effective and efficient;
  • coordination by community health registered nurses, who can navigate the complex system of resources for chronically ill patients; and
  • regular home visits by registered nurses, who can assess problems specific to the home environment of patients.

A randomized clinical trial to assess Care Plus begins in 2011. It will assess the effect of the program on a patient population with a high burden of chronic disease.