Building a Medical Home, Piece by Piece
"It takes a village to treat the most complex patient," says Mary Norine Walsh, MD, medical director of heart failure and cardiac transplantation at Care Group/St. Vincent's Health System in Indianapolis. She was one of four participants examining the patient-centered medical home model for the roundtable cover feature, "Who Should Own the Medical Home?" "But the responsibility for these patients rests with the physician—the specialty physician," she concludes.

The medical home model, if fully realized, may serve as that village: a community of healthcare providers working together to ensure coordinated and individualized high-quality care. To be functional, a patient-centered model needs to be integrated and include proper incentives that reward effective and efficient use of resources. And it requires a physician leader who takes ownership of not only the patient but the process of care, the panelists agree. For complex cases, the most suitable leader may be the specialist. For others, it may be the primary care physician.

At present the medical home may look more like a house under construction with some but not all components in place.

This issue offers a few examples of programs that stand on their own but could be integrated into a medical home design. Baylor Medical Center Garland in Texas, for instance, implemented a pilot nurse-led transitional care program that reduced 30-day heart failure readmissions by almost 50 percent. This month's ACC Corner describes how Midwest Heart Specialists in suburban Chicago uses its EHRs to meet federal quality performance measures, with payments now offsetting some of the EHR's costs.

The cath lab also offers more opportunities for improving patient care and the use of resources. With increasing awareness on appropriate stenting, interventional cardiologists turn to imaging technologies to help make decisions before and during procedures to achieve optimal results. And cath lab directors share strategies for keeping costs in line without sacrificing patient care.

In the end, both sweeping programs like the medical home and more modest efforts like improving EHRs help make a village that is better able to treat the complex cardiac patient.