September 23, 2016|Categories:
Welcome back to Population Health(ier), a recurring series featuring athenahealth and The Atlantic’s best storytelling on America’s population health revolution. To catch up on our series, you can find last week’s story here. Today, we explore how community-based and patient-centered medical homes can help to strengthen the communities they serve.
How do you help a patient who seems uninterested in his or her own care? A referral to a specialty doctor may not reap what it sows. An order for exams may fall on deaf ears. A prescription for medication may be left unfilled.
Though nearly one in four Americans live in rural communities, only one in ten physicians practice there, creating a deficit of critical care in areas which arguably need it most. When transportation is lacking, hospitals are far, and physicians are few, the capacity for patients to receive the care they require is problematic at best—and fatal at worst.
Dr. David Loxterkamp, a primary care physician at the Seaport Community Health Center in Belfast, Maine, is no stranger to the challenging medical situations of patients in rural communities.
Take Paul. A patient suffering from Type 1 diabetes, Paul seemed indifferent to his medical care. He wasn't monitoring his blood sugar or administering insulin shots, and he was eating poorly. In conversation with Paul, Dr. Loxterkamp discovered that he was relying on his grandparents for care. Dr. Loxsterkamp brought Paul's grandparents into the health center to discuss their nutrition, diet, and the importance of managing their grandson’s diabetes.
Dr. Loxterkamp's approach to Paul's care and others like him is rooted in his clinic's model as a Patient-Centered Medical Home (PCMH). A PCMH acts as a partnership between families and physicians to deliver primary care that is, in the words of the American Academy of Pediatrics, “accessible, family-centered, coordinated, comprehensive, continuous, compassionate, and culturally effective.” PCMHs are holistic health centers, tackling everything from mental health to primary care to dentistry--a small and robust foundation of healthcare within the community.
PCMHs may be seen as a sort of “one stop shop” for healthcare, but Dr. Loxterkamp is working toward a more individualistic approach for each patient. He compares today’s healthcare to an assembly line: “Fifteen different people will meet you and ask what seems like virtually the same questions, and then somehow we send you out into the community and hopefully tie it all together so that nothing is lost in care management.” For PCMHs, the health center is the home of care management, striving to be self-sufficient and all-inclusive, with no important information—or patients—getting lost in the fray.
The Patient-Centered Medical Home has emerged as an effective model, particularly for delivering the kind of remote care delivery that rural communities need. PCMHs use systems and services that connect via cloud-based technologies and digital portals, so that the transferal of critical care information between providers and to patients functions seamlessly.
Sara Levy, practice director at Seaport, confirms that in a community based on intimate relationships and reliant upon communication, the services provided by PCMHs exact what, literally and figuratively, the doctor ordered. “The claim that ‘so-and-so is elderly, they’re not going to pick up a laptop’ is becoming less true, but it’s still there,” Levy says. “It’s about creating more programs and giving the medical team more tools and opportunities to better serve the community.”
Ultimately, creating a medical home—a true home, with a stable structure and a family of physicians who support and serve—is a first step in rekindling the important feeling of community that those in rural areas may have lost. “Our job,” concludes Dr. Loxterkamp, “is only—simply—to get them back in those communities and reengaged with the people who have given them the purpose for living.”
To experience an interactive feature along with access to the full Population Healthier series, visit The Atlantic.