What are “Medical Homes” and How Are They Revolutionizing Primary Care?

The American healthcare system is broken. That's what you hear everyone saying these days, no matter where people live or how well they actually understand the issues.

The Los Angeles-based UniHealth Foundation is tired of hearing the complaints and has the money to start doing something about it on the grassroots level. The foundation started paying attention when UCLA and USC began working together to mend the system with the concept of “medical homes” as the focal point.

A “medical home” is a patient-centered plan to provide team-based, coordinated care, aimed at making the primary care team central to the patient's health needs. On the surface, this strategy doesn't sound much different from anything that's been done before. But Dr. David Goldstein, who envisioned the concept and conceived the Galaxy Health Program, says its innovation is making this vision a reality in a complex, disconnected health care system.

The UniHealth Foundation awarded a three-year $750,000 grant to kick off the project. (Read UniHealth Foundation: Los Angeles Grants).

Goldstein's Galaxy program established 24/7 access to physicians, made urgent care clinic appointments available within a couple hours, and coordinated emergency care. “My hope was that Galaxy would reveal that a minimal investment and reorientation in delivery focused on the patient and enhanced access to care could improve the satisfaction of patients, staff and physicians, even in an underfunded public environment,” Goldstein said. “I think it worked out well. It’s not rocket science.”

Although the UniHealth Foundation still hasn't announced its new grantmaking initiatives, the program funding all goes to either Los Angeles and northern Orange County hospitals or to a general purpose fund. This $750,000 grant helped to create a call center, telephone renewal of prescriptions, and the availability of up to five urgent care appointments per day.

Primary care isn't only an important issue for the here and now, it's also a major concern for the future. Fewer and fewer medical school graduates are going into primary care because of the long hours, lack of support, and low salaries. There's already a shortage of primary care physicians in the area, and this situation is expected to become even more crucial as more baby boomers retire and develop aging-related health issues.

Although the Galaxy Health Program is certainly a step in the right direction, it still has a long way to go. Among the clinics that participated in the program, none satisfied all the elements needed to quality as a “medical home.” The clinic's overall score moved from 35/100 to 53/100. And the composite satisfaction score for residents went up from 39% to 51%. While those new figures would still qualify as an “F” in any classroom, a slow and steady approach is certainly better than no progress at all.