Analysis: Medical homes cut care disparity

WASHINGTON, June 28 (UPI) -- Patients who belong to "medical homes" -- medical practices that provide patients with a sense of consistency and accessibility -- experience none of the racial disparity commonly documented in the rest of the healthcare world, according to a recent study

Healthcare disparity manifests itself in different aspects of treatment, including access to care and the quality and quantity received, with whites and Asian-Americans generally faring better than African-Americans and Hispanics in a survey sponsored by the Commonwealth Fund, a private organization that promotes healthcare research.

While only 21 percent of whites ages 18 to 64 were uninsured in 2006, almost half of Hispanics in the same age group and 28 percent of African-Americans lacked coverage.

At the same time, 43 percent of Hispanics and 21 percent of African-Americans had no regular source of care, compared to 15 percent of whites.

However, even when individuals do not have insurance, if they receive care in a medical home, the disparities appear to vanish.

"This is not the same sad, sad story of disparities exist and we should do something about it," said Anne Beal, a senior program officer at the Commonwealth Fund, at a panel discussion Wednesday on the survey. "Whenever patients said that they were in a medical home, we found that there were no disparities in terms of quality of care that they receive."

The term "medical home" does not refer to brick-and-mortar, but to a mentality through which a practice approaches care. The Commonwealth survey identified those being treated in a medical home by asking respondents if they had a regular provider or place of care and whether their physician could be easily reached via phone, provided night and weekend care, and ran an organized office.

As policymakers discuss measures to improve the quality of healthcare, equity should be an important part of any solution, making medical homes a particularly attractive possibility, said Garth Graham, deputy assistant secretary for minority health at the U.S. Department of Health and Human Services.

"We can't leave out this issue of cultural competency," Graham said. "I remember when I was in medical school, we would learn about biochemistry, we would learn about everything else, and then the last class that everyone would skip out of in the afternoon, was ... about patient care and patient interaction."

Some current legislation in the Senate focuses on increasing cultural training for physicians as one way to reduce disparity.

The Minority Health Improvement and Health Disparities Elimination Act, sponsored by Sen. Barack Obama, D-Ill., pushes the holistic treatment approach outlined in the medical home model.

In addition to setting up a Web site with cultural information for practitioners, it emphasizes disease management programs and coordination between clinical care and other public service programs, such as transportation or interpretation services.

The whole-patient approach to treatment decreases disparity because it empowers patients to follow through with their healthcare needs, said Anna Maria Izquierdo-Porrera, medical director for the Spanish Catholic Center, whose patient population consists mostly of uninsured ethnic minorities.

"It's (having) someone that, at the end of the day, you can trust to do what they're asking you to do," Izquierdo-Porrera told United Press International. "For me, that is the concept of a medical home: having a place where you can go where people know you."

Without consistent, coordinated care from a personal physician, it's hard for patients to build a trusting relationship with their provider, Izquierdo-Porrera said, particularly for individuals who move frequently or have no home at all. Some patients also face language barriers that make it difficult for them to understand or implement treatment regimens.

But despite the benefits associated with medical homes, the current pay structure deters many physicians from implementing the model in their practices, said Rick Kellerman, president of the American Academy of Family Physicians.

"The payment system only pays me when the patient is right in front of me in the examination room and there's all this other background stuff that has to go on, too," Kellerman told UPI.

For instance, physicians receive no compensation for time they spend consulting with patients over the phone, discussions with family members about how to care for an elderly parent or reminders to receive preventive procedures.

However, some doctors have been able to successfully implement the medical home ideal, even in private practice. Nicole Lang, president of Washington Pediatrics Associates, provides family-centered care for her patients and manages to stay in business, although she didn't pay herself the first year.

"Our mission is really to deliver comprehensive medical care and take care of the whole child," Lang said.

The practice offers a host of extra services, including a nutritionist, a weight management program, lactation consultants, parenting classes, infant massage classes and a literacy program. And patients pay only a small fee -- or none at all if they're on Medicaid -- to use these services.

But providing all of this places a financial strain on the practice -- one that Lang said could be eased if government and employers jumped on board with the program.

"If we work together and know there are going to be better outcomes if patients are followed closely, it's a win-win situation," she said.