Several years ago, when I first heard the term Medical Home, I was intrigued. As a healthcare designer, my thoughts were immediately consumed by the facility implications. What would this do to the outpatient environment as we know it? How would the space have to change? What would the community building look like?
I soon learned “Medical Home” is a concept or strategy for the business of delivering healthcare. But, of course, with this progressive model for resolving a number of pressing issues on today’s care system, facility-related solutions are a must to create optimum team synergy and the best patient experience.
As the tongue-in-cheek title of this blog implies, there are several ways of modeling a business that involve shared savings to meet the impending demand of caring for more lives in an age of reform. There are some basics I’ll list here as a starting point in which a facility can accomplish much of what restructuring the delivery of primary care sets out to do.
• Team-based Care. Based on the Center for Medical Home Improvement www.medicalhomeimprovement.org, one provider (MD) overseeing three to four mid-level providers (APN, RN, NP), with the mid-level provider serving as the main contact point with patients and performing most of the exams. The MD has a small panel of higher acuity patients and oversees the mid-level provider’s patients. This team also includes, care coordination, triage nurses, scheduling, social work and consulting specialists to provide fully integrated care.
Facility Implication. Need areas for team consultation, team-assigned exam and diagnostic spaces accompanied by patient consultation spaces. Arrangement of rooms is critical to enhance efficiency of flow for patient intake, care and check-out.
• Personalized Care. The entire care team should know the members in their panels and should be familiar with their medical records. They should be able to speak to them about their health status and ask focused informed questions to address concerns quickly without having to go back and research their records.
Facility Implication: Adequate office and consultation spaces, IT support, adequate capacity in systems and readily located electronic records.
• Wellness vs. Illness. The medical home is built on a model of preventative care. This includes annual checkups, maintenance of chronic illnesses, (asthma, diabetes, obesity, etc.) in an outpatient setting rather than waiting until they have an episode that necessitates an emergency visit or inpatient stay. This also includes preventative screenings and educational programs.
Facility Implication: Real estate issues of visibility, ease of access, parking and capability of handling drop-ins. Group education spaces for classes.
• One stop shopping. The medical home should have all the services that the care team needs to serve the complete health of their patients. This also enhances the care team’s ability to monitor whether patients are following their care plan, taking their medications and have no barriers to increasing their health.
Facility Implication: Distinct areas for primary care, OB care, specialty care, nutrition and other health education, a laboratory, pharmacy/DME, PT/OT/speech, dental, vision, imaging and minor procedures and minor urgent care.
The realization that a medical home isn’t your father’s neighborhood doctor office creates a greater opportunity to establish a well-run medical home clinic in an accessible, recognizable location. By designing for efficiency and convenience, the patient’s confidence in healthcare options, even the familiarity necessary to build important relationships with their medical team, leads to greater opportunities for prevention of more costly chronic and acute care.
For more on the impact of Medical Homes, see www.fkp.com/medical home
Dan Killebrew is a partner at Dallas-based FKP Architects.