‘Medical Home’ Care Model

By Dr. Nate Fujimoto
Interviewed by Rasa Fournier
Wednesday - July 13, 2011
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Dr. Nate Fujimoto
General practitioner at Kaiser Permanente

Where did you receive your schooling and training?

I received my master’s degree in public health from the University of Hawaii School of Public Health and my M.D. from the University of California at Irvine School of Medicine. I returned to Hawaii to complete my internal medicine residency.

How long have you been practicing?

More than 25 years.

What is Patient-Centered Medical Home?

It’s a health care model that focuses on the relationship a patient has with his or her personal care physician, or PCP, who is supported by a team of health care professionals that helps to coordinate all of the different aspects of a person’s care. PCMH started with pediatrics in the late 1960s, and has gained momentum on a national scale over the past five years because it’s a primary care model that results in better quality while slowing down the rising cost of health care. Patients benefit from this because the entire system revolves around their needs, not the other way around. Kaiser Permanente’s model matches perfectly with PCMH, and we are well on our way to certifying all of our clinics and primary care providers this year.

Why is it only gaining popularity now?

The traditional model of medical care in the United States is fee-for-service, which experts in public health and health care financing say tends to encourage more care versus better care. PCMH fixes that by encouraging quality and prevention, and focusing on outcomes rather than volume. Quality-based programs like PCMH are becoming popular with health care organizations across the country. Kaiser Permanente is one of several nationally renowned health care organizations leading the way, because the way we deliver health care is so closely aligned with the medical home model.

Denise Fujiyama (nursing supervisor), Stephanie Cui (licensed practical nurse), Lace Hatcher (PCMH project manager) and Michelle Soto (process excellence consultant) with a board displaying a core process for PCMH. Nathalie Walker photo .(JavaScript must be enabled to view this email address)

Can you talk about the benefits of electronic medical records?

The delivery of medical care is complex. Patients often see multiple physicians and other health care disciplines for their different health care needs. Without a means for all these providers to communicate with each other, care can become fragmented. The electronic health record makes it possible to share medical information in a secure and confidential way, enhancing the coordination of care between providers and reducing the chance of duplicate testing. All of our primary care and specialty physicians and health care providers, including those working in the emergency room and our Moanalua Medical Center, have been using an integrated electronic health record for several years now. So if I send a patient to a specialist, I’ll be able to see their notes, what diagnostic tests were done, and what advice and medications were given. And my colleagues will be able to see the same information I see, so there’s less chance of miscommunication and less chance of errors. In addition, many electronic health records, like the one we use, allow patients to see their own health information online. The more information my patients have about their health, the better they can share in the health care decisions we make together.

Are most systems moving toward the PCMH model and electronic records?

PCMH is just taking off. The National Committee on Quality Assurance (NCQA), an accrediting body for health insurance plans, has taken the lead on this. They certify physician practices that meet certain criteria: patientphysician relationship, team-based care, quality and safety, coordination of care and enhanced access. Kaiser Permanente has met all of these criteria for many years. Care can be provided over the telephone or electronically. We’ve offered secure email messaging at kp.org for more than five years, where patients can review their lab results, make appointments online and send nonurgent emails to their provider. In addition, patients can speak to an advice nurse who has access to their medical information and physicians on-call even when the clinics are closed. The idea is that the patient has access to care 24 hours a day, seven days a week.

With PCMH, do doctors end up busier with patients receiving increased access?

They might during the initial transition, but access is improved when the physician-led team practices together within the scope of their license, and patients begin to understand that there is always someone who can help them. Because of this, many often choose not to come in for a face-to-face appointment because they can get their needs taken care of over the phone or via email if it’s more convenient for them. When you have an integrated model of care where doctors, physician assistants, midwives, nurses, APRNs (advanced practice registered nurses), pharmacists, therapists, dieticians, social workers, hospital, emergency room, lab and X-ray providers are all aligned and supported by an integrated electronic health record, it makes it easier to do what’s in the best interest of the patient.

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