‘Medical home’ models must be patient-centered to improve experiences
CHICAGO — Advances in medical treatment, including the increased use of biologics, in recent years has led to a marked improvement in the control of inflammation in patients with immune mediated inflammatory diseases, such as inflammatory bowel disease.
However, Miguel Regueiro, MD, chair of the department of gastroenterology, hepatology and nutrition at the Cleveland Clinic, said despite this improved treatment, many patients experience medical problems that require multiple visits that drive up costs.
“What is interesting about these rare, chronic diseases is that high-utilizer patients are what drive up the cost,” Regueiro said during his presentation at the Interdisciplinary Autoimmune Summit. These patients, according to Regueiro, experience psychosocial, mental health and pain problems not directly related to inflammation that lead to more visits.
“It’s the whole-person impact,” he said.
To address these problems that go beyond strictly what is brought on by chronic disease, physicians have been working to develop medical home models that are built around what patients need. Regueiro helped establish one of these “homes” while at the University of Pittsburgh Medical Center, and he is working to build one now at the Cleveland Clinic.
Regueiro stressed that these medical homes must be patient-centered and designed from the bottom up to improve patient experience. His center enlisted volunteer patient-stakeholders to provide feedback about their visit to find out exactly what they were doing right, and what they were doing wrong. The patients listed 37 things that were wrong during their visit and highlighted only one that that was done right.
“I asked, ‘what was the one thing right?’ They said, ‘you smiled when you came in the room,’” Regueiro said. “But the 37 things that were wrong were not necessarily about me, but they hated the scheduling. They hated the phone calls. They couldn’t make an appointment. They hated the parking ... If we don’t ask our patients what is important to them in their narrative and their journey, we will never know.”
The medical home model is made up of a group that includes specialists, nurses, psychologists and social workers, as well as dieticians, assistants and embedded schedulers. Every member collaborates and engages patients to ensure every step and aspect of their care is personal.
“The secret sauce to any of these population-based health initiatives is the mind-to-body relationship,” Regueiro said. “If we don’t account for some of the psychosocial elements of the disease, our best treatments only get us so far.”
While this complex approach may seem daunting, Regueiro said the collaborative nature these medical home models present an opportunity to reduce burnout for the providers involved.
“Yes, there are still challenges,” he said. “I was actually worried going into this that the burnout was going to be higher ... When you start doing team-based care and working with a team, actually the satisfaction goes up, and the burnout starts to go down.”
While the challenge of reaching more patients remains, the medical home model presents an opportunity to expand access through telemedicine and virtual visits. Regueiro said that can be as simple as staying committed to making follow-up calls between visits to skype-based hypnotherapy from the team’s psychologist. As he works with his team to build up the IBD medical home at the Cleveland Clinic, Regueiro said they hope to utilize technology to incorporate their primary care base and implement a simple referral system.
“We are, through the e-consult system, coming up with at triage in terms of referral into the medical home that is going to be algorithmically based but very easy,” he said. “It has to be a simple button.” – by Alex Young
Regueiro M. “Patient Centered Medical Homes for IMIDs.” Presented at: Interdisciplinary Autoimmune Summit; April 5-7, 2019; Chicago.
Disclosure: Regueiro reports no relevant financial disclosures.